Ephraim T Yeheyis and Ayalew T Tamire
A Broncho Biliary Fistula (BBF) is a rare complication of echinococcosis. This occurs from rupture of a hydatid cyst located at the upper surface of the liver into the bronchial tree. Fistulisation, results in biliopytsis, which is expectoration of bile-tinged greenish-yellow sputum, a pathognomonic feature of BBF. Bilopytsis may also occur in other conditions such as hepatectomies, liver abscesses or trauma. Surgical fistula closure is the definitive management of these patients, however downstream biliary obstruction should be ruled out first. Almost all cases can be approached through a right postero-lateral thoracotomy followed by phrenotomy. However, if there are multiple cysts in the liver, a thoraco-abdominal incision may be necessary.
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