Bronchobiliary fistula secondary to biliary stricture after hepatectomy.

A 63-year-old woman with compensated HCV-induced liver cirrhosis underwent a right hepatectomy through thoracophrenolaparotomy due to a giant hydatid cyst (segments 6, 7, 8) in 1977, which developed an external biliary fistula complication from 1980 on. Twenty-six years after hepatectomy, at the time of external biliary fistula close, she showed expectoration of bile, and bronchoscopy discovered bile in the bronchial tree. Magnetic resonance cholangiography and percutaneous transhepatic cholangiography showed a common hepatic duct stricture, intrahepatic duct dilation, and bronchobiliary fistula. Due to its benign character, we decided to treat the stricture with dilation and placement of a bile drainage, thus solving the situation. Bronchobiliary fistula is an uncommon condition usually seen in endemic regions as a complication of hydatid or amoebic disease (4). In Western society, bile obstruction, Fig.1.Magnetic resonance cholangiography: a filiform stricture at the common hepatic duct (red arrowhead), and dilation of the left intrahepatic duct (short red arrow). Bronchobiliary fistula (long red arrow). Colangio RM donde se aprecia una estenosis filiforme del conducto hepático común y colédoco proximal (cabeza de flecha roja), que recupera en su porción distal su calibre normal, y produce una dilatación de la vía biliar del lóbulo hepático izquierdo (flecha roja corta). Se visualiza además un trayecto fistuloso (flecha roja larga), que comunica el sistema biliar con una colección subdiafragmática. Fig. 2.Percutaneous transhepatic cholangiography: a common hepatic duct stricture (short white arrow), bronchobiliary fístula (white arrowhead), and the basal bronchus (long white arrow). Imágenes colangiográficas (CTH) donde se observa la estenosis del hepático común (flecha blanca corta) y relleno de contraste del trayecto fistuloso (cabeza de flecha blanca), la cavidad subdiafragmática y un bronquio basal (flecha blanca larga).