Thoracobiliary fistula developing at a late stage after a gushot injury

Thoracobiliary fistula (TBF) is a rare but highly serious complication of thoraco-abdominal trauma. The most significant factor in the early diagnosis of TBF is considered to be a laceration of the diaphragm and accompanied mostly by hepatic injury in the trauma of lower thoracic region. Fever, chills, biliptysis, abdominal and chest pain, pleural effusion, hepatomegaly and leucocytosis are among the most common presenting symptoms of TBF. Existence of indirect biliribun in sputum and/or pleural fluid is also supporting agents in the diagnosis. Even though there exist no optimal management of TBF, surgical and conservative approaches in its management are available. In cases where TBF treatment is started late, development of bile empyema with acute necrotizing bile bronchiolitis, pneumonia and sepsis is inevitable. In this article, a biliary-bronchial fistula case, which developed as a late complication after a gunshot injury and resulted in mortality, is presented.