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Background Bronchobiliary fistula is an infrequent but severe complication following microwave ablation for hepatic malignancy. This study aims to enhance the understanding and management of BBF. Methods From November 2015 to September 2023, nine patients diagnosed with BBF following microwave ablation for hepatic malignancy were treated at the Shanghai Eastern Hepatobiliary Surgery Hospital. The clinical, diagnostic, and treatment characteristics were analyzed. Results Biliptysis was presented in 100% of the patients. Fever occurred in 77.8% of the patients. Only two patients underwent bilirubin tests for pleural fluid and one patient for sputum all of which returned positive results. All the patients had pneumonia and pleural effusion. A fistula connecting the biliary lesion to the lung was only revealed on MRI in one patient. Other findings included hepatic abscess biloma and subphrenic fluid collection. All patients underwent minimally invasive procedures such as pleural drainage (5/9) percutaneous transhepatic cholangial drainage(5/9) endoscopic nasobiliary drainage (5/9) and endoscopic retrograde biliary drainage (2/9). Only one patient underwent surgical intervention after other minimally invasive interventions failed. Among the patients three achieved a complete cure as evidenced by the complete disappearance of symptoms including coughAnd biliptysis, And they remain alive to date. Three patients witnessed An improvement in their symptoms, with a notable reduction in manifestations such as cough and biliptysis. Regrettably, they later succumbed to liver cancer. Three patients still had repeated biliptysis symptom after minimally invasive interventions and died from 2 months to 11months after the appearance of biliptysis. Conclusion Bronchobiliary fistula is a rare but serious complication of microwave ablation for hepatic malignancy, marked by biliptysis as a key symptom. Sputum bilirubin testing offers a simple diagnostic tool. Minimally invasive treatments like percutaneous transhepatic cholangial drainage and endoscopic nasobiliary drainage are effective, while surgery may be needed for refractory cases. Early intervention improves outcomes.

The case reported in this paper is a vascular‐bronchial fistula associated with fatal massive hemoptysis. The patient was rescued successfully by experts from a multidisciplinary team. The bronchoscopy physician cleared the accumulated blood in the airway timely and maintained the airway patency, and the anesthesiologist established artificial ventilation quickly; eventually, the thoracic surgeon performed an emergency thoracotomy to control the bleeding. It reflected the significance of multidisciplinary collaborative treatment. The case reported in this paper is a vascular‐bronchial fistula associated with fatal massive hemoptysis. The patient was successfully rescued by experts from a multidisciplinary collaborative team. The bronchoscopy physician timely cleared the accumulated blood in the airway and maintained the airway patency, and the anesthesiologist quickly established artificial ventilation; eventually, the thoracic surgeon urgently performed a thoracotomy to control the bleeding. This reflects the significance of multidisciplinary collaborative treatment.

Oesophageal duplication cysts are a subtype of foregut cysts, associated with the presence of ectopic gastric mucosa. Gastric acid secreted by this mucosa can lead to complications. We report one such unusual case of complication leading to the formation of broncho-oesophageal fistula in a duplication cyst. A girl in her middle childhood presented with a long-duration cough and multiple respiratory infections. On investigation, a right-sided paraoesophageal air-filled cystic lesion was identified, with a possible communication with the airway, confirmed by an oral contrast study. On further workup, a positive uptake was noted on Meckel’s scan, signifying the presence of ectopic gastric mucosa. The findings were confirmed surgically and on histopathology and were consistent with a duplication cyst with broncho-oesophageal fistula. An unexplained upper respiratory tract symptomatology should mandate imaging, which would enable early detection and appropriate surgical management of such cysts in infancy and childhood.

Introduction Bronchopleural fistula is a rare but potentially fatal complication of pulmonary resections and proper management is essential for its resolution. In this study, we analyzed the incidence of fistula after pulmonary resection and reported data about endoscopic and conservative treatments of this complication. Methods From January 2003 to December 2013, 835 patients underwent anatomic lung resections: 786 (94.1 %) had a lobectomy and 49 (5.9 %) a pneumonectomy. Bronchopleural fistula was suspected by clinical signs and confirmed by endoscopic visualization. Results Eighteen patients (2.2 %) developed a bronchopleural fistula, 11 in lobectomy group (1.4 %) and 7 in pneumonectomy group (14.3 %). The fistula size ranged between <1 mm and 6 mm and mean time of fistula onset was 33.9 ± 54.9 days after surgery. Of 18 patients who developed fistula, one died due to acute respiratory failure and another one was reoperated and then died to causes unrelated to the treatment. All the remaining 16 patients were treated with a conservative therapy that consisted in keeping or replacing a drainage chest tube. Nine of them underwent also endoscopic closure of the fistula using biological or synthetic glues. The mean period of time elapsed for the resolution of this complication was shorter with combined (conservative + endoscopic) than with conservative treatment alone (15.4 ± 13.2 vs. 25.8 ± 13.2 days, respectively), but without significant difference between the two methods ( p : 0.299). Conclusion Endoscopic therapy, associated with a conservative treatment, is a safe and useful option in the management of the postoperative bronchopleural fistula.

Background A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment. Case presentation BEF presented in a 40-year-old female patient 8 years after curative treatment with pneumonectomy and radio-chemotherapy for advanced lung cancer. She had autoimmune comorbidity, a single lung, vocal cord paralysis and an extremely hostile thorax. Multi-disciplinary collaboration, close patient involvement and evaluation by the hospital medical ethics committee were key elements in the following treatment course. After temporary stent treatment, a carefully staged surgical marathon was performed: Veno-venous ECMO was established to secure oxygenation, and bilateral thoracotomy and laparotomy performed to access structures in the frozen mediastinum. After extensive thoracoplasty and high-risk dissection, esophagectomy was performed and the 20 × 35 mm bronchial defect repaired by bronchoplasty with a latissimus muscle flap. It was complicated by thrombotic occlusion of the upper venous system, repeated postoperative bleedings and critical illness neuropathy. The patient recovered and was discharged 150 days after surgery. Within 1–2 years bronchoscopy showed a smooth undiscernible bronchoplasty with a stable open left main bronchus. At 5 years the patient lives an independent life at home with her family. Conclusions Surgical treatment of BEF in an extremely complex patient may turn out successfully. It demands careful ethical considerations, comprehensive surgical strategy, multi-disciplinary teamwork, and shared decision making with the patient. The patient presented in this case report is closely followed up with good life quality after 5 years.

Gastrobronchial fistula (GBF) is a rare surgical complication after bariatric surgery. We aimed to identify the clinical aspects of GBF and establish diagnostic and treatment strategies. A literature search was conducted in December 2013, in the PubMed electronic database. Eleven studies were selected, comprising a total of 36 patients. Most patients presented with a gastric leak prior to the diagnosis of GBF. Mean period until diagnosis was 7.2 months, and main presenting symptoms were productive cough ( n  = 13) and subphrenic abscess ( n  = 12). Endoscopic treatment was successful in 18 out of 20 patients, with minimal complication. Surgical treatment was successful in 17 cases with significant complications. GBF can be effectively treated with both endoscopic and surgical approach; however, surgical treatment can be associated with more complication.

We described two cases with idiopathic bronchoesophageal fistula presented recurrent postprandial coughing. Abnormal tracts connecting the oesophagus and bronchus were identified by videofluoroscopy. Thoracoscopic surgery was successfully performed, which involved the resection of the fistula and the interposition of a pedicle of viable parietal pleura between oesophageal and bronchial closures. Neither patient experienced symptoms of any subsequent complications.

Introduction Bronchobiliary fistulas are rare and difficult to treat. Peacock first reported this entity in 1850 while treating a patient with hepatic encopresis. Case presentation A 67-year-old Chinese male patient presented to the outpatient clinic with a complaint of coughing up phlegm with chest tightness for 4 days with symptoms of intermittent bilirubin sputum with a sputum volume of about 500 ml per day but no symptoms of abdominal pain or jaundice and no yellow urine or steatorrhea. The examination revealed cyanosis of the lips and mouth, barrel chest, low breath sounds on the right side, and a large number of wet rales heard in both lungs. The imaging investigations were suggestive of bronchobiliary fistula. Therefore, the patient was operated on and discharged with no perioperative complications. Conclusion Bronchobiliary fistula should be considered diagnostically in patients with known liver disease who also experience trauma or medical treatment and cough up bile-colored sputum, regardless of the presence of concurrent infections, and in conjunction with radiological expertise to identify it. Here, we report a case of bronchobiliary fistula and a brief review of the literature on it.

Closure of bronchopleural fistula remains a difficult challenge for clinicians. Although several therapeutic approaches have been proposed, the clinical results are commonly unsatisfactory. Previous reports have indicated that autologous mesenchymal stem cells (MSCs) are useful for aiding treatment of bronchopleural fistula. We report here the use of umbilical cord MSCs to effect the successful closure of a bronchopleural fistula (5 mm) in a 33-year-old woman 6 months after a lobectomy. A review of the relevant literature is included. The use of MSCs may be a promising therapeutic method for the closure of bronchopleural fistula. Randomized controlled trials with larger samples are required.