Multidisciplinary approach in the treatment of patients with bilio-pleuro-pulmonary fistulas

Abstract

Post-opbilio-pleuro-pulmonary fistulas are extremely rare, but a serious complication can develope vena few year safter surgery. The article presents the experience of effective stage-by-stage separation of bilio-pleuro-pulmonary fistulas that occurred in patients at various times after surgical interventions on the liver.

The purpose of the article was to analyze, develop and generalize modern endoscopic methods of treatment in patients with hepatic pathology complicated by the development of bilio-pleuro-pulmonary fistulas.

Materials and methods of the study: clinical observations of two patients who were admitted for inpatient treatment in the differential diagnostic department of the State Medical Institution «TB Dispensary» of the Ministry of Health of the KBR (Kabardino-Balkarskaya Republic) in 2020 and 2021 are presented. Two patients developed pleuro-pulmonary complications after surgical interventions on the liver. The severity of the patients‘ condition at admission was due to increasing respiratory insufficiency as a result of the development of bilateral aspiration pneumonia, which prevented endotracheal anesthesia and abdominal surgical interventions. The patients underwent temporary endoscopic valvularbronchoblocking in combination with selective drainage of the pleural cavity. When assessing the condition of patients 24–48 hours after the interventions, positive clinical dynamics, relief of biliophthysis, elimination of biliothorax were noted, and during the control X-ray examination in the postoperative period, closure of the bilio-pleural and broncho-pleural fistulas was noted. Thus, this method allowed to stop the aspiration syndrome and achieve clinical stabilization of patients, which made it possible to prepare them for radical surgical interventions aimed at the final elimination of pathological bilio-pleuro-pulmonary communication. For the first time, the tactics of a complex step-by-step approach to the treatment of this category of patients  was used, aimed at temporarily delineating the vicious biliaryrespiratory communication. In the article, the algorithm is proposed, step-by-step examination and treatment of patients with biliopleuro-pulmonary fistulas, to prepare patients for radical surgical interventions. The proposed therapeutic and diagnostic algorithm can be recommended for use in medical institutions with specialized hospitals.