Bronchobiliary Fistula: A Challenging Opponent to Treat in Stage IV intrahepatic Cholangiocarcinoma (iCC) Patients

A 57-year-old female underwent a left hemihepatectomy due to intrahepatic cholangiocarcinoma (iCC) in 2017. Asymptomatic for two and a half years, in 2020, the patient was admitted to the department due to cholangitis and tumor recurrence. The patient underwent four Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures in total and Percutaneous Transhepatic Biliary Drainage (PTCD). As for palliative oncological treatment she underwent radio-chemotherapy. Six months following PTCD, another ERCP was performed exchanging external biliary drainage to internal. Seven months following the last radiotherapy, a Bronchobiliary Fistula (BBF) was identified. Quality of life remained hugely impaired, with associating dyspnoea, fatigue and a persistent chronic cough with biliary sputum. The patient was treated symptomatically. BBF was treated throughout the next two years through consecutive ERCP’s with biliary stenting as well as continuous PTCD implementation until the patient’s death in 2022. Curative treatment of bronchobiliary fistulas in stage IV iCC is challenging and associated with major mortality risk. The most reasonable strategies available in treating such patients are through ERCP with biliary stenting and PTCD, thus, surgery and other treatment options remain limited.