Management of Bronchobiliary and Thoracobiliary Fistulas

Bronchobiliary and thoracobiliary fistulas represent pathological communications between the biliary system and the thoracic cavity, manifesting as bile leakage into the bronchial tree or pleural space. Although rare, these fistulas carry significant morbidity and mortality and may arise from hepatic interventions, trauma, infection or congenital defects. Patients typically present with bilioptysis, recurrent chest infections or pleural effusion, often leading to delayed diagnosis. Cross-sectional imaging techniques—such as contrast-enhanced CT, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiography—play a central role in delineating fistula anatomy and guiding therapy. Management strategies range from non-surgical interventions, including percutaneous biliary drainage and endoscopic stenting, to definitive surgical repair encompassing fistulectomy, primary closure or tissue-flap reinforcement. Decision-making depends on fistula size, underlying hepatic pathology and patient comorbidities. A multidisciplinary team ensures that less invasive approaches are attempted first, reserving surgery for refractory or complex cases. Advances in interventional radiology and endoscopy have reduced the need for extensive thoracotomy and liver resection, improving recovery times and functional outcomes. The global rise in hepatic ablation procedures has underscored the importance of early recognition and a tailored therapeutic algorithm to optimise patient safety and preserve hepatic and pulmonary function.

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Management of Bronchobiliary and Thoracobiliary Fistulas publication trend

The graph below shows the total number of articles in management of bronchobiliary and thoracobiliary fistulas across all publications each year (not limited to Nature Index journals).

Technical terms

Bronchobiliary fistula: An abnormal communication between the biliary tract and the bronchial tree, leading to bile in the airways.

Pleurobiliary fistula: A tract connecting the biliary system to the pleural space, causing bile-coloured pleural effusion.

Bilioptysis: Expectoration of bile-stained sputum, a pathognomonic symptom of bronchobiliary fistula.

Radiofrequency ablation: An image-guided thermal technique for tumour destruction that may inadvertently damage biliary structures.

Interventional biliary stenting: Endoscopic or percutaneous insertion of a tube to divert bile flow and facilitate fistula healing.

References

1. Bronchobiliary fistula after ablation of hepatocellular carcinoma adjacent to the diaphragm: Case report and literature review. Thoracic Cancer (2020).
2. Management of acquired bronchobiliary fistula: 3 case reports and a literature review. Journal of Cardiothoracic Surgery (2007).
3. Thoracobiliary fistulas: literature review and a case report of fistula closure with omentum majus. Radiology and Oncology (2013).