Treatment of bronchobiliary fistula: a 13-year experience

Background Bronchobiliary fistula (BBF) is a rare but fatal disease. Only a limited number of cases have been reported, resulting in a lack of consensus on appropriate treatment strategies. Methods We retrospectively analyzed the clinical data of 17 patients with BBF between 2012 and 2025, including the main symptoms, diagnosis, treatment and prognosis. Results All 17 patients had cough and pathognomonic biliptysis. Sputum examination revealed bile components in all samples from 3 patients, and fiber bronchoscopy identified yellow-green bilious sputum in 6 patients. Computed tomography (CT)/ magnetic resonance imaging (MRI) demonstrated a connection between the bile duct and the bronchial tree in 9 patients. Cholangiography showed that the contrast agent entered into the bronchi through the sinus tract in 10 patients. Surgical intervention was performed on 6 patients, while 11 underwent minimally invasive treatments, including percutaneous transhepatic cholangial drainage (PTCD), nasobiliary duct, and bile duct stent. During a median 3 years follow-up, 9 of 17 patients survived. Mortality causes included: malignancy progression (n = 3), postoperative complications (pneumothorax/respiratory failure n = 1; hemorrhagic shock/ disseminated intravascular coagulation n = 1), septic shock post-transplant (n = 1), and uncontrolled BBF with septic/hepatic failure (n = 2). Conclusions BBF carries a poor prognosis. Minimally invasive therapies effectively palliate malignant cases, while surgery offers potential cure for select benign disease. Treatment requires individualized, multidisciplinary strategies.