title: Bronchobiliary fistula: a rare complication of hepatic endometriosis.
abstract: OBJECTIVE
  To report the case and surgical therapy of a patient with bilioptysis after vaginal delivery, caused by bronchobiliary fistula. Histologic analysis revealed endometrial glands embedded in the decidual stroma neighboring the liver and the lung.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 39-year-old patient, 7 days after vaginal delivery, without endometrial history.
  
  
  METHODS
  Synchronous liver and lung resection of a bronchobiliary fistula by laparotomy and a transdiaphragmatic approach.
  
  
  METHODS
  For complicated brochobiliary fistula caused by endometriosis, radical surgical treatment is mandatory.
  
  
  RESULTS
  Histopathologic analyses confirmed the presence of clusters of endometrial glands embedded in the decidual stroma that were neighboring the liver, and perifistulous lung tissue was shown to contain biliary pigment absorbed by macrophages and their derivatives.
  
  
  CONCLUSIONS
  Hepatic and perihepatic endometriosis can cause a bronchobiliary fistula. Exacerbation of the symptoms can be triggered by high estrogen levels, physiologically dominating the last trimester. For such a rare case, surgery is mandatory.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of the Saarland, Homburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schuld
authors.forename: Christoph
authors.initials: C
authors.lastname: Justinger
authors.forename: Mathias
authors.initials: M
authors.lastname: Wagner
authors.forename: Rainer M
authors.initials: RM
authors.lastname: Bohle
authors.forename: Otto
authors.initials: O
authors.lastname: Kollmar
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schilling
authors.forename: Sven
authors.initials: S
authors.lastname: Richter
mesh_terms: D000328:Adult; D001658:Biliary Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D001983:Bronchial Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D049590:Postpartum Period