Bronchobiliary fistula successfully treated surgically

Bronchobiliary fistula is a rare condition, arising as a complication of hydatid disease of the liver, hepatic tuberculosis, hepatic malignancy, chronic pancreatitis, hepatic trauma or surgery. Patients characteristically present with recurrent bilioptysis, and in the chronic stage, develops bronchiectasis of the affected segment of the lung. Conservative treatment is directed at non-surgical approaches of relieving biliary obstruction to allow for normal flow of bile into the duodenum via endoscopy or percutaneous routes. However in complicated cases which failed conservative non-surgical therapy, surgical intervention is usually required. We report a 29-year-old Malay man who presented with chronic bilioptysis from a bronchobiliary fistula resulting from occlusion of a biliary stent inserted to treat intrahepatic biliary strictures. This was successfully treated surgically with a right medial lobectomy and interposition of a piece of viable tissue between the fistula stump on the dome of the diaphragm and the remaining lung.