Bronchobiliary fistula [thoracobilia]: Report of two cases

ABSTRACT

Bronchobiliary fistula is a rare condition, defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the development of such a communication. Infection is the most common setting in which bronchobiliary fistulae occur [Amebic abscesses, echinococcic liver cysts and pyogenic liver abscesses]. Biliary tract obstruction secondary to various causes also has served as a common etiology. Congenital cases of bronchobiliary fistulae have been noted. The condition also usually seen as a complication of thoraco-abdominal trauma. Adult patients with bronchobiliary fistulae present with one of two clinical syndromes either acute fulminating bronchiolitis or chronic intermittent episodes of expectoration of bile-stained sputum [billoptysis] which is a pathognomonic feature of bronchobiliary fistula. Diagnosis is confirmed by means of either the percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, or 99m Tc-HIDA cholescintigraphy [HIDA scan]. Herein, we reported two cases, the first one due to transdiaphragmatic rupture of a hepatic echinococcal cyst and the second case detected after a right hepatic labectomy for hepatocellular carcinoma