Keywords
bronchoperitoneal fistula - pneumoperitoneum -
Klebsiella pneumoniae
Introduction
Bronchoperitoneal fistulae are rare with seven case reports in literature. Most of
the cases reported were due to erosion of diaphragm and lung parenchyma by subdiaphragmatic
infection. In this case report, we report a case of bronchoperitoneal fistula secondary
to right lower lobe Klebsiella pneumoniae, managed conservatively by percutaneous drainage (PCD) and antibiotics. The knowledge
of this entity is important in diagnosis of fistula as fistulous connection can be
overlooked in the imaging and can lead to misdiagnosis of hollow viscus perforation
and mismanagement
Discussion
Bronchoperitoneal fistulae are rare. There are very few case reports of bronchoperitoneal
fistula in the literature.[1]
[2]
[3]
[4]
[5]
[6]
[7] Bronchoperitoneal fistulae occur due to erosion of the diaphragm, pleura and lung
parenchyma and are commonly associated with retained drainage tube, lung abscess,
acute respiratory distress syndrome, subphrenic collection due to cholecystectomy,
duodenal perforation, and synechotomy in patients on ventilation. Most commonly bronchoperitoneal
fistulae are seen due to spread of infection from caudal to cranial direction.[1]
[2]
[3]
[4]
[5]
[6]
[7] There is only one case report mentioning the bronchoperitoneal fistula due to primary
lung abscess.[5]
Management of bronchoperitoneal fistula is not clear. Various management protocols
are described that include surgical closure of diaphragmatic defect, high frequency
oscillatory ventilation, and conservative management.[1]
[2]
[3]
[4]
[5]
To our knowledge, this is the first case report of a bronchoperitoneal fistula secondary
to cavitating pneumonia, which was managed conservatively with PCD and antibiotics.
The knowledge of this entity is important in diagnosis of fistula as fistulous connection
can be overlooked in the imaging and can lead to misdiagnosis of hollow viscus perforation
and mismanagement.
