Surgery often brings rare and life-threatening conditions to light. One such unusual complication is a hepatico-broncho-pleural fistula (HBPF) — a condition where an abscess in the liver ruptures through the diaphragm into the pleural cavity and lung. If untreated, this can lead to severe infection, respiratory failure, and even death.

Here, I present a rare and challenging case of a young middle-aged male with an amoebic liver abscess that ruptured into the pleural cavity and lung, successfully treated with advanced surgical intervention at my center in Hubli.

Patient Case Presentation

 

A middle-aged gentleman arrived with:

Severe breathlessness

Persistent cough

Coughing up blood-stained, "anchovy sauce-like" material

He had a history of abdominal pain and loose motions, which indicated a previous amoebic infection.

 

Diagnosis and Findings

 

Investigations revealed:

A large amoebic liver abscess

Loculated pleural effusion

Communication of the abscess through the diaphragm into the pleural cavity

Involvement of the lower lobe of the lung, which had become diseased

Diagnosis: Hepatico-Broncho-Pleural Fistula secondary to ruptured amoebic liver abscess

 

 

Initial Stabilization

 

The patient was initially managed with an Intercostal Drainage (ICD) tube, which helped drain the pleural pus and stabilize his condition.

 

Definitive Surgical Treatment

 

A definitive surgery was then planned and performed:

Thoracotomy with pleural decortication

Right lower lobectomy (removal of diseased lung lobe)

Debridement of the liver abscess cavity

Repair of the diaphragmatic perforation

Drainage of abdominal and pleural cavities

 

Recovery and Outcome

 

The patient had an excellent recovery in 14 days

His breathing and cough improved completely

No recurrence of symptoms on follow-up

He continues to remain healthy and active

 

Discussion

 

Hepatico-broncho-pleural fistula is an exceptionally rare complication of amoebic liver abscess. Early diagnosis, careful stabilization, and advanced surgical expertise are critical to successful outcomes.

This case highlights the importance of multidisciplinary surgical care involving hepatobiliary, thoracic, and gastrointestinal surgery. Minimally invasive and advanced surgical techniques significantly improve patient outcomes in such rare and complex cases.

 

Conclusion

Rare and life-threatening conditions like hepatico-broncho-pleural fistula can be successfully treated with timely diagnosis and advanced surgery.

With over 25 years of experience in laparoscopic, endoscopic, gastrointestinal, and cancer surgery, I am committed to delivering world-class surgical care to patients in Hubli and beyond.