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The diagnosis and management of broncho-abdominal fistula in critically patients is difficult, with various treatment options including medical, surgical, ventilatory strategies and drainage systems. We report the case of a 58-year-old male patient who presented acutely with systemic sepsis 41 days after undergoing an elective laparoscopic cholecystectomy. The patient underwent a 34-day course of intensive care treatment during which the diagnosis of a broncho-abdominal fistula was made using a simple technique previously undescribed in the critical care literature. The case was subsequently managed successfully following the introduction of high frequency oscillatory ventilation (HFOV) as the principal mode of respiratory support. We describe the unusual presentation, the method of diagnosis and the subsequent management of this case using HFOV.

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