A bronchobiliary fistula (BBF) is an abnormal communication between the biliary and bronchial systems. It is a rare condition with an unclear etiology. The principal causes are hepatic hydatid cysts, obstructive and iatrogenic processes. Presenting symptoms are variable and range from productive cough to recurrent pneumonia. The finding of bilioptisis is patognomonic. This case report presented a 22-year-old female patient who underwent a Roux-en-Y hepaticojejunostomy (RYHJ) for a bile duct injury and who later on, developed a bronchobiliary fistula.

Bronchobiliary fistula (BBF) represents a rare disorder; it consists of abnormal interconnection between the biliary tract and bronchial trees. A 22-year-old woman with persistent chest pain, jaundice, and biliptysis was referred for hepatobiliary scintigraphy under clinical suspicion of a BBF. Patient medical history was consistent with biliary tree reconstruction secondary to an iatrogenic injury during cholecystectomy 4 years ago. Previous complementary studies (CT and MR cholangiopancreatography) were equivocal for diagnosis. Planar dynamic images of hepatobiliary scintigraphy in the first hour were inconclusive. A 24-hour SPECT/CT was performed and confirmed the BBF in a minimally invasive way.