Appropriate approach to bronchobiliary fistulas: a case series with hydatid disease and algorithm of case-based management.

Bronchobiliary fistula caused by liver echinococcosis is a relatively unusual but severe complication of hydatid disease. Optimal management of cases is crucially important in establishing rapid recovery and avoiding additional complications. The use of an algorithmic guide is essential because of an ongoing dilemma that involves a large variety of therapeutic options. We present four patients with bronchobiliary fistulas caused by liver hydatid disease to discuss the management of therapeutic options through a case-based approach and an extent review to finally generate an algorithm. In this series, two patients were treated surgically, and the remaining were treated with conservative methods. To date, they have developed neither recurrence nor need for additional intervention. Although treatment of bronchobiliary fistulas is traditionally thought to be surgical, most of the less severe cases can be treated nonoperatively. Making an accurate selection among less invasive methods and/or open surgical interventions seems to be a key component of management.