2024 Volume 31 Issue 6 Pages 591-594
Bronchobiliary fistula, characterized by bile leakage into the bronchial tree and consequent chemical pneumonia is rare, and currently, there is no consensus regarding the treatment strategy. An 82-year-old man developed recurrent chronic respiratory infection secondary to bronchobiliary fistula after treatment for hepatocellular carcinoma. He had a history of external choledochostomy with stable symptoms. However, external drainage tube obstruction caused chemical pneumonia with bile aspiration. His respiratory condition worsened, which necessitated intensive care unit admission, and he was intubated using a double-lumen tube. Differential lung ventilation was performed to protect the contralateral lung. After changing the external drainage tube to the bigger one, the bile reflux volume was evaluated using a bronchoscope when changing the ventilator settings, changing the patient’s body position, and at initiation of enteral nutrition, which reduced bile reflux and improved the patient’s respiratory status. Protection of the contralateral lung and prompt control of bile reflux with external drainage are essential in patients with bronchobiliary fistula.
