Broncho-Biliary Fistula Due to Hydatid Disease: Case Report

Abstract

A Broncho Biliary Fistula (BBF) is a rare complication of echinococcosis. This occurs from rupture of a hydatid cyst located at the upper surface of the liver into the bronchial tree. Fistulisation, results in biliopytsis, which is expectoration of bile-tinged greenish-yellow sputum, a pathognomonic feature of BBF. Bilopytsis may also occur in other conditions such as hepatectomies, liver abscesses or trauma. Surgical fistula closure is the definitive management of these patients, however downstream biliary obstruction should be ruled out first. Almost all cases can be approached through a right postero-lateral thoracotomy followed by phrenotomy. However, if there are multiple cysts in the liver, a thoraco-abdominal incision may be necessary.

Spontaneous bronchobiliary fistula: Case report

“…Infections resulting in a subdiaphragmatic abscess or necrotizing lung infections can predispose to BBF. It can even be the result of an iatrogenic injury in hepatic surgery or local treatment, such as a radiofrequency ablation [2,3,4]. Only a few cases of congenital BBF are reported [2,5].…”

“…The first involves biliary tract obstructions (caused by scar tissue, tumors, inflammatory diseases) leading to bile retention proximal to the barrier with consequent formation of a biloma and subsequent formation of an abscess, which gradually erodes the diaphragm. In the second mechanism the abscess formation takes place without biliary tract obstruction and it is most frequently due to an echinococcal hydatic cyst [3,6].…”