Broncho-biliary fistula caused by a left hydatic cyst: a case report

Broncho-biliary fistula (BBF) of hydatid origin is a rare complication due to an abnormal communication between the biliary tract and bronchial tree, affecting abdominal, diaphragmatic, and thoracic levels. Although BBF is already infrequent, its occurrence on the left side is exceedingly rare and scarcely documented in the literature. We report a 34-year-old woman with left-sided BBF caused by a segment II hepatic hydatid cyst (60 × 82 mm), presenting with bilioptysis and pneumonia resistant to antibiotics. Initial laboratory tests revealed marked hepatic cytolysis and cholestasis, with no clinical improvement despite appropriate antibiotic therapy with levofloxacin 500 mg twice daily for 14 days. CT revealed a type IB BBF per Mestiri's classification. Surgical management via laparotomy included cystectomy, fistula closure, and diaphragmatic repair. Operative time was approximately 135 min. There were no intraoperative complications. This case illustrates a rare left-sided BBF managed effectively via an abdominal approach alone, avoiding thoracotomy. The decision was based on lesion accessibility, cyst location, and avoidance of gastric injury. This case emphasizes the importance of precise preoperative imaging and highlights that laparotomy alone may be sufficient in selected left-sided BBF cases, avoiding more invasive approaches like thoracotomy.