BILORRHEA SECONDARY TO BRONCHOBILIARY FISTULA

Purpose: Bronchobiliary fistula (BBF) is a rare condition with significant morbidity which has been reported to occur most commonly as a complication of hydatid cyst liver disease. This case describes a patient who presented with biliptysis six months following decortication of an empyema which had occurred following partial hepatectomy of a colon cancer metastasis. This is the only case to our knowledge which describes the presentation of a BBF in this context. Its purpose is to highlight an unusual presentation of a condition that occurs most commonly in the United States following surgical repair of trauma to the thoracic cavity. Methods: This presentation provides a detailed explanation of a case that allows the reader to gain knowledge about the various ways in which this particular disease process can present. Results: The patient was diagnosed with BBF and successfully underwent open thoracotomy for fistulectomy and repair. Conclusions: BBF presents a unique and interesting diagnostic challenge, and highlights the importance of a thorough history and physical exam. This condition may arise in a patient with parasitic disease, in patients having undergone previous surgery, or in chronically ill patients with a long history of surgeries, abscesses, or radiofrequency ablation therapy. The prognosis in patients with BBF depends on their ability to tolerate surgery, their overall state of health prior to diagnosis (including their ability to undergo a lobectomy), and recognition of this condition early in its course. Direct open fistulectomy and repair is the most definitive approach to repairing BBF, and with complete drainage and successful repair of the diaphragm provides curative treatment with excellent prognosis for patients with this condition.