[Biliobronchial fistula due to hydatidosis of the liver and choledocholithiasis].
BACKGROUND
Biliobronchial fistula (BBF) is an abnormal communication between the biliary system and bronchial tree due to trauma, hemiheptectomy benign biliary stricture with cholangitis and necrotic hepatic infections such as hydatid disease. Intratoracic rupture of a hydatis cyst of the liver is a rare but severe complication with an incidence about 1% and mortality rate about 10%.


METHODS
A 50-year-old male patient presented with cough, episodes of biliary expectoration and haemoptysis followed with fever, fatigue and dyspnea. The diagnosis was set by echosonography, Chest x-ray finding, CT scan, bronchoscope aspirates while bronchography did not show results. The surgery was done through right subcostal laparotomy. A hydatid cyst was found in the right liver lobe its diameter being 10 cm, fixed with diaphragm. Intraoperative cholangiography revealed choledocholithiasis (two calculi), dilatation of bile ducts and communication of right hepatic duct with the irregular liver cavity as well as with the bronchi of the right lower pulmonary lobe. Cholecystectomy, choledocholitotomy with drainage lavage of bile ducts pericystectomy and cyst evacuation was performed, followed by diaphragm necrosectomy. The postoperative period and control cholangiography through T drain were normal.


CONCLUSIONS
The surgical treatment has five goals: to treat the liver cyst, secure free biliary drainage, perform hepatodiaphragmatic disconection, solve intratoracic lesion and restore the diaphragm. We believe these goals could be achieved through abdominal approach except for irreversible bronchiectasis, intratoracal collection and chronic pulmonary sepsis.


CONCLUSIONS
In any case, a surgery still remains the treatment of choice in cases of echinococcosis. Most cases can be solved by laparotomy.
Bilanović
Dragoljub
D
Klinicko bolnicki centar "Bezanijska kosa", Beograd, Hirurska klinika. majadare@eunet.yu
Zdravković
Darko
D
Tosković
Borisav
B
D001658:Biliary Fistula / Q000209:etiology*; D001983:Bronchial Fistula / Q000209:etiology*; D042883:Choledocholithiasis / Q000150:complications* / Q000601:surgery; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged