SURGICAL AND ENDOSCOPIC MANAGEMENT OF BILIO-BRONCHIAL FISTULA SECONDARY TO RUPTURED HYDATID CYSTS OF THE LIVER: -EXPERIENCE OF A MOROCCAN CENTER-

Introduction: The bilio-bronchial fistula (BBF) is an anomalous communication between the bile ducts and the tracheobronchial tree, which complicates several hepatobiliary pathologies but the most common, in our location, remain the hydatic origin. Through 5 clinical cases, we report our experience of multimodal management of this pathology. Patients and Methods: The positive diagnosis was based on clinical, radiological and endoscopic arguments. All patients were treated according to two components: the first is an assessment and a correction of any associated biological disorders with a drainage of any pleural collection. The second therapeutic component consists in performing an endoscopic sphincterotomy to remove any individualized bile duct's obstacle. Surgical treatment was indicated only in case of the failure of the medical and endoscopic management. Results: Five patients were included. In 03 patients, follow-up showed a clear clinical, biological and radiological improvement and the surgical cure of bilio-bronchial fistula was not indicated. In the 02 other patients, thoracic surgical approach was decided for a destruction of the right pulmonary lower lobe and because of the persistence of a pleural collection. The surgical follow-up was simple. The two operated patients were discharged 07 days after surgery and anti-helminthic treatment was initiated. Conclusion: An adequate preoperative patient's preparation combining both the correction of the biological disorders and the introduction of endoscopic sphincterotomy made possible the exclusive thoracotomy with satisfactory results and fistula healing.