Successful management of bronchobiliary fistula with histoacryl/lipiodol mixture under endoscopic guidance

Abstract

Bronchobiliary fistula (BBF) is a rare complication of liver microwave ablation (MWA), in which an abnormal communication between the biliary tract and bronchial tree is formed. This case report describes successful management of BBF following multiple wedge resections and MWA in a patient with metastatic neuro-endocrine tumour (NET) of the ileocaecal valve. After simultaneous right hemicolectomy, with resection and MWA of numerous liver metastasis, he developed BBF. Numerous attempts with endoscopic stenting failed to achieve sufficient biliary drainage and relieve the biloptysis. The patient was effectively treated by endoscopically injecting a 2ml mixture of histoacryl glue and lipiodol which formed a seal at the previous fistula site. Post procedural symptomatic improvement was achieved and endoscopic contrast injection at high pressure showed the seal was still intact. Surgeons should be aware of this technique for patients with persistent bronchobiliary fistula prior to considering other surgical options.