Biliobronchial or bronchobiliary fistula (BBF) is a rare complication due to abnormal connection between the biliary system and bronchial tree. It has different etiologies included congenital and acquired causes such as obstruction of biliary tract, infection, trauma, malignancy and even some therapeutic procedures. Patients usually present with respiratory symptoms and bilioptysis (bile in sputum) that is a pathognomonic sign for BBF. The sputum analysis and imaging can be used for diagnosis of BBF. Treatment consisted of Endoscopic or percutaneous drainage for biliary decompression and open surgery if noninvasive approach is not successful.

We described a 38 year-old man with fever, dyspnea, cough and copious yellow-greenish sputum. He had a history of laparoscopic cholecystectomy 2 years ago due to cholecystitis and had undergone a repeated surgery because of bile peritonitis due to bile duct injury and bile leakage. During the recent hospitalization, he was diagnosed with pneumonia. Consolidation in right lower lobe of lung and liver abcsess with gases was seen in CT images. Bronchoscopy showed bile stained secretions in respiratory tract. High bilirubin level was revealed in the fluid obtained from bronchoalveolar lavage. Percutaneous and endoscopic dilatation and stenting was not successful because of severe stricture of bile duct. Hence, surgical approach was performed. At dome of right diaphragm a biliobronchial fistula with adhesions was seen and segmental resection of the involved lung with diaphragmatic repair was done. Liver abscess was drained and hepaticojejunostomy was performed for biliary stricture. The condition of patient dramatically recovered after surgery.

Biliobronchial fistula is a rare complication that should be considered in patients with bilioptysis. We introduced a BBF resulted from stricture and obstruction of biliary tract due to bile duct injury after laparoscopic cholecystectomy. BBF may cause significant complication especially without proper diagnosis or treatment.