Thoracobiliary fistulas: Report of six cases

Abstract

Thoracobiliary fistula is an uncommon clinical syndrome characterized by the presence of an abnormal communication between the biliary system and the chest. Expectoration of bile and occasionally biliary calculi is typical of a fistulous tract between the biliary passages and the bronchial tree. These fistulas are usually formed as a complication of hepatic amoebiasis and echinococcosis. Thoracotomy, evacuation of the subphrenic space-occupying cyst or abscess, and drainage of the residual cavity with tubes exteriorized through the abdominal or thoracic wall is the treatment of choice. Resection of the infected segment of the affected lung tissue may be necessary. Removal of the biliary obstruction is the first step to be taken in patients with common duct obstructions to decrease the high pressure in the biliary tree. Thoracotomy and closure of the fistula is the second step in these cases. Morbidity and mortality rates in thoracobiliary fistulas have been diminished with the use of reconstructive surgical methods.