Bronchobiliary fistula due to acute cholecystitis in a suprahepatic gall bladder

We describe a patient presenting with painless jaundice, anorexia and pruritus. The gall bladder was found to be lying above and behind a hypoplastic right lobe of liver. There was no evidence of cholangitis or biliary obstruction. The patient subsequently developed a bronchobiliary fistula with severe wheeze, cough and bile-stained sputum. Emergency percutaneous drainage of the gall bladder led to immediate cessation of bronchospasm and biloptysis, rendering the patient fit for definitive surgery.