Bronchobiliary fistula complicating open cholecystectomy.

Post operatively she developed an air and bile leak. A subsequent ERCP was performed and the plastic biliary stent removed from the bile duct. There was a suspicion of contrast in the bronchial tree on this examination. A further CT scan demonstrated a pleural effusion, diaphragmatic disruption and a collection under the diaphragm consistent with bronchobiliary fistula. Her bilioptysis settled when the drain from the defect in the diaphragm was connected to an underwater seal. The air and bile leak slowly diminished allowing removal of the drains. She remained well at follow up two months later.