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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 hepatico comun y coledoco proximal (cabeza de flecha roja), que recupera en su porcion distal su calibre normal, y produce una dilatacion de la via biliar del lobulo hepatico izquierdo (flecha roja corta). Se visualiza ademas un trayecto fistuloso (flecha roja larga), que comunica el sistema biliar con una coleccion subdiafragmatica. Fig. 2.Percutaneous transhepatic cholangiography: a common hepatic duct stricture (short white arrow), bronchobiliary fistula (white arrowhead), and the basal bronchus (long white arrow). Imagenes colangiograficas (CTH) donde se observa la estenosis del hepatico comun (flecha blanca corta) y relleno de contraste del trayecto fistuloso (cabeza de flecha blanca), la cavidad subdiafragmatica y un bronquio basal (flecha blanca larga).

Bronchobiliary fistula secondary to biliary stricture after hepatectomy