A Case of Bilio-Bronchial Fistula Presenting With Bilioptysis Following Hepatocellular Carcinoma Treatment.

This report describes a rare case of a bilio-bronchial fistula in a 60-year-old man with a complex history of hepatocellular carcinoma, treated with resection, trans-arterial chemoembolisation and microwave ablation. Following ablation, a pre-existing sterile liver seroma became infected, forming an abscess that eroded through the diaphragm, culminating in a fistula between the biliary tree and the bronchial system. The pathognomonic presentation of bilioptysis (bilirubin-rich sputum) confirmed the diagnosis, which was further visualised on endoscopic retrograde cholangiopancreatography. Management successfully focused on biliary system decompression via endoscopic stent placement into the culprit duct. This intervention resulted in the immediate cessation of bilioptysis and subsequent fistula healing, thereby avoiding high-risk surgical repair. This case highlights that bilio-bronchial fistula is a potential complication of liver ablation therapies and underscores the critical role of endoscopic biliary drainage as a first-line, minimally invasive treatment to reduce intrabiliary pressure and promote spontaneous closure.