NON-SURGICAL RESOLUTION OF A BRONCHOBILIARY FISTULA FOLLOWING HEPATIC HYDATID CYST SURGERY USING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Öz

Bronchobiliary fistula (BBF) is a rare pathological communication between the biliary and bronchial trees. It most frequently arises as a secondary complication of hepatic hydatid disease, trauma, or hepatobiliary surgery. Among these, ruptured or inadequately treated hepatic hydatid cysts are the most common. Diagnosis remains clinically challenging due to the nonspecificity of symptoms and their overlap with pulmonary infections. We present the case of a 34-year-old man with a history of hepatic hydatid cyst treated via deroofing surgery, complicated by postoperative bile leak. Eight months later, the patient developed progressive bilioptysis, a productive cough, and respiratory distress. Computed tomography revealed a right-sided pleural effusion, collapsed lower lobe, and a hepatic cystic lesion with a fistulous tract crossing the diaphragm. The diagnosis was confirmed using bronchoscopy and endoscopic retrograde cholangiopancreatography (ERCP). The patient was successfully managed with endoscopic biliary sphincterotomy and repeated plastic stent placement. Significant clinical improvement was observed, with complete resolution of bilioptysis and no further complications on follow-up. BBF is an uncommon but serious complication of hepatic hydatid disease and prior hepatobiliary surgery. A high clinical suspicion, timely imaging, and endoscopic evaluation are crucial for diagnosis. ERCP with biliary stenting and sphincterotomy is a safe and effective non-surgical treatment modality, especially in stable patients, offering excellent clinical outcomes and avoiding the morbidity associated with open surgical interventions.

Anahtar Kelimeler

• Bronchobiliary fistula
• Hydatid cyst
• Biliptysis
• Non-surgical management
• ERCP

Kaynakça

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