Bronchobiliary fistula. Endoscopic management

Bronchobiliary fistula is an infrequent condition, and there is no consensus on the most effective methods of diagnosis and treatment. The authors present two cases of bronchobiliary fistula. The suspicion of a fistula was made on bronchoscopy examination, when bile was found within the bronchial tree. Examination of a sample taken from the bronchial tree proved to contain bilirubin. In both patients, a complicated abscess of the right lobe of the liver caused bronchobiliary fistula. The abscess had developed due to a disturbance in the outflow of bile (purulent inflammation of the bile ducts due to a bile stone and scarring of the ampulla of Vater). A final diagnosis can be established with endoscopic retrograde cholangio-pancreatography. During endoscopy, a stent was placed in the right hepatic duct. Two months later a control endoscopic retrograde cholangio-pancreatography examination was performed. No leakage of contrast agent from the biliary ducts into the bronchial tree was found and the stent was removed. Endoscopic retrograde cholangio-pancreatography and procedures made during this examination are an up-to-date method of treatment of bronchobiliary fistula.