Persistent bronchobiliary fistula managed by endoscopic biliary stenting

A 26-year-old man presented with right hypochondrium pain, fever and copious greenish-yellow expectoration for 15 days (Panel A). He had undergone laparotomy with peritoneal lavage for ruptured amoebic liver abscess 1 month back.

Chest X-ray showed a homogenous opacity over the right lower zone with pleural effusion (Panel B). CT scan described a trans-diaphragmatic bronchobiliary fistula (BBF) and a large abscess in the right lobe of liver containing fluid and air specks (Panel C).

The patient was initially managed with a right intercoastal drainage tube (ICDT) and percutaneous drainage of liver abscess to which he responded favorably and his sepsis resolved. However, ICDT output remained high (~300 mL/day) even after 2 weeks, indicating chronic BBF. He was taken up for endoscopic biliary decompression. Cholangiogram demonstrated a fistulous connection between bile duct and right bronchial tree (Panel D). Following biliary stenting, both expectoration and chest drain output drastically decreased and resolved completely by day 4.

Acknowledgements

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Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Informed Consent: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.