ArticleWorld journal of transplantation2026
Bronchobiliary fistula in fibrolamellar hepatocellular carcinoma with anesthetic challenges during living donor liver transplantation: A case report.
Article in World journal of transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFibrolamellar hepatocellular carcinoma (FL-HCC) is a rare malignancy that may lead to complex postoperative complications, including brochobiliary fistula (BBF). CASE SUMMARY: We report a 21-year-old patient with pulmonary metastatic FL-HCC, previously treated with multiple liver ablations, left lung wedge resections, and thoracic radiation, who subsequently developed a right-sided BBF. The patient presented for living donor liver transplantation after persistent bilioptysis and recurrent infections despite biliary drainage and prior surgical repair. Intraoperative management was challenging. A left-sided double-lumen tube was used to isolate the left lung and avoid positive-pressure ventilation of the fistulized right lung. However, one-lung ventilation resulted in hypoxia requiring return to two-lung ventilation with continuous suctioning. Surgical dissection was prolonged due to dense adhesions between the liver, right hemidiaphragm, and lung, causing major blood loss and necessitating rapid, high-volume transfusion of blood products.
conclusionThis case underscores the significant airway, ventilation, and hemorrhage challenges encountered during liver transplantation in patients with persistent BBF and extensive thoracoabdominal adhesions.
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