Korean J Hepatobiliary Pancreat Surg.  2013 Aug;17(3):135-138. 10.14701/kjhbps.2013.17.3.135.

Surgical treatment of bronchobiliary fistula due to radiofrequency ablation for recurrent hepatocellular carcinoma

  • 1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dwchoi@skku.edu


Bronchobiliary fistula (BBF) is a rare complication of radiofrequency ablation (RFA), in which there is abnormal communications between the biliary tract and the bronchial trees. Surgery should only be considered for BBF when non-invasive interventions have failed. In this report, we describe the surgical management for BBF when complicated by an abscess that was encountered after RFA in a 52-year-old woman with recurrent hepatocellular carcinoma (HCC). She had previously undergone central bisectionectomy of HCC 7 years ago, and had been treated with a sixth transarterial chemoembolization and first RFA for recurrent HCC after the operation. After the liver abscess and BBF occurred in the posterior section of the liver, she received posterior sectionectomy and hepaticojejunostomy, drainage of the lung abscess, diaphragmatic resection and repair because it was impossible to drain the abscess radiologically. Symptomatic improvements were being achieved through operative treatments where pleural effusion and pneumonic consolidation was obliterated on a 2-months follow-up image.


Bronchobiliary fistula; Radiofrequency catheter ablation; Hepatocellular carcinoma; Hepatectomy

MeSH Terms

Biliary Tract
Carcinoma, Hepatocellular
Catheter Ablation
Follow-Up Studies
Liver Abscess
Lung Abscess
Middle Aged
Pleural Effusion


  • Fig. 1 Endoscopic retrograde cholangiopancreatography shows structure of the common hepatic duct (arrow) and mild dilatation of the left and right hepatic ducts.

  • Fig. 2 Abdominal CT reveals another newly appeared abscess pocket in the right basal lung and a fistula (arrow) showing communications between the radiofrequency-ablated cavity in the liver and the bronchial tree, including the pneumonic consolidation involving the middle right and lower lobes of the lung.

  • Fig. 3 (A) Operative field after right posterior sectionectomy and primary repair of the diaphragmatic defect shows exposure of left biliary stent (clamping with curved forceps) and opening of the left hepatic duct (arrow). (B) Schematic figure.

  • Fig. 4 (A) Preoperative chest X-ray shows pleural effusion and pneumonic consolidation in the lower right lobe of the lung. (B) A follow-up chest X-ray taken 2 months after operation demonstrates improvements of pneumonia and pleural effusion in the right basal lung.


1. Yilmaz U, Sahin B, Hilmioglu F, et al. Endoscopic treatment of bronchobiliary fistula: report on 11 cases. Hepatogastroenterology. 1996; 43:293–300. PMID: 8682482.
2. Liao GQ, Wang H, Zhu GY, et al. Management of acquired bronchobiliary fistula: a systematic literature review of 68 cases published in 30 years. World J Gastroenterol. 2011; 17:3842–3849. PMID: 21987628.
3. Chua HK, Allen MS, Deschamps C, et al. Bronchobiliary fistula: principlesof management. Ann Thorac Surg. 2000; 70:1392–1394. PMID: 11081906.
4. Peacock TB. Case in which hydatids were expectorated and one of suppuration of a hydatid cyst of the liver communicating with the lungs. Edinburgh Med Surg J. 1850; 74:33–46.
5. Kim YS, Rhim H, Sung JH, et al. Bronchobiliary fistula after radiofrequency thermal ablation of hepatic tumor. J Vasc Interv Radiol. 2005; 16:407–410. PMID: 15758140.
6. Jung SI, Goo JM, Han JK, et al. Recurrent bronchobiliary fistula: unsuccessful management with repeated insertion of metallic biliary stent. J Vasc Interv Radiol. 2003; 14:1577–1579. PMID: 14654496.
7. Hibi T, Sakamoto Y, Asamura H, et al. Successful resection of hepatocellular carcinoma with bronchobiliary fistula caused by repeated transcatheter arterial embolizations: report of a case. Surg Today. 2007; 37:154–158. PMID: 17243037.
8. Pende V, Marchese M, Mutignani M, et al. Endoscopic management of biliopleural fistula and biloma after percutaneous radiofrequency ablation of liver metastasis. Gastrointest Endosc. 2007; 66:616–618. PMID: 17521647.
9. Goldman SY, Greben CR, Setton A, et al. Bronchobiliary fistula successfully treated with n-butyl cyanoacrylate via a bronchial approach. J Vasc Interv Radiol. 2007; 18:151–155. PMID: 17296718.
10. Yoon DH, Shim JH, Lee WJ, et al. Percutaneous management of a bronchobiliary fistula after radiofrequency ablation in a patient with hepatocellular carcinoma. Korean J Radiol. 2009; 10:411–415. PMID: 19568472.
Full Text Links
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr