A Multidisciplinary Approach to a Bronchobiliary Fistula after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Mucinous Adenocarcinoma of the Ovary

Other causes included bile duct obstruction (30.8%), hepatic hydatid (11.7%), trauma (10.2%), chronic pancreatitis (2.9%), and one case each of hepatic abscess, subphrenic abscess, syphilis gummosa, and acute cholecystitis, with biliptysis present in all patients.1 In this case report, we describe the first reported instance of a BBF after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for mucinous adenocarcinoma of the ovary and our attempt to treat it nonoperatively. A 63-year-old female, with a past medical history of peptic ulcer disease, splenic artery aneurysm, and a surgical history of an open appendectomy and laparoscopic cholecystectomy, presented to the ED with abdominal pain, distension, nausea, and vomiting. The surgery included radical pelvic dissection, total abdominal hysterectomy, bilateral salpingo-oophorectomy, right diaphragmatic peritonectomy, right diaphragm nodule resection, liver wedge resection, gastric omentectomy, and abdominal wall nodule resection. A higher success rate of fistula closure was obtained in patients with a fascial patch graft (100% vs 40%).3 The idea to use muscle flaps for intrathoracic defects was first described by Abrashanoff in 1911 with the first use of the latissimus dorsi in 1938.4 General considerations for flap reconstruction are to bring in well-vascularized tissue to assist in defect closure as well as fill residual dead space.