Current Thoracic Surgery 2023 , Vol 8 , Issue 2
Abdominothoracic fistulas due to complicated Echinococcosis: surgical treatment and outcome
Yekta Altemur Karamustafaoglu1,Fazlı Yanık1,Yener Yoruk1
1Department of Thoracic Surgery, Trakya University, Faculty of Medicine, Edirne, Turkey DOI : 10.26663/cts.2023.0017 Viewed : 1413 - Downloaded : 405 Background: Abdominothoracic fistulas are severe complications of hydatid disease. We report here on the results of treatment of hydatid abdominothoracic fistulas in 17 patients.

Material and Methods: A single-center case series of 17 patients with abdominothoracic fistulas (ATF) was treated at our hospital from 2004 and 2019. Nine men and eight women patients (age range: 46-85 years; median age: 59 years) were treated for abdominothoracic fistulas (ATF). The main symptoms were dyspnea, chest pain, cough, purulent sputum, high fever in 15 patients and additionally biliptysis in two patients. Fistulas were hepatopleural (HPF) in 14, bronchobiliary (BBF) in two and abdominopleural in one patient.

Results: Fourteen patients were operated for HPF and 3 (18%) patients were treated with percutaneous transhepatic drainage and tube thoracostomy. All patients were discharged from the hospital in good health. Our strategy consisted of adequate evacuation of the intrahepatic cyst,closure of the fistula via thoracophrenotomy and long term drainage of the intrahepatic or subhepatic cyst space up to ceased biliary drainage.

Conclusions: ATF due to hydatid cyst is uncommon. In rare cases ATF may be present at the abdominal,thoracic or diaphragmatic level. Thoracophrenotomy is the best surgical treatment for all three levels.In unstable patients only long-term percutaneous drainage should be applied. Medical treatment with Albendazole is indicated when dissemination is confirmed. Early diagnosis and management of septic associated complications are main goal. Keywords : abdominopleural fistula, complication, cyst hydatid