Thoracobiliary fistula. A rare complication of thoracoabdominal trauma

Thoracobiliary fistulas (bronchobiliary and pleurobiliary) are rare complications of thoracoabdominal trauma. Owing to their rarity, there is little consensus on the optimal management. The diagnostic suspicion however must be considered and it's important the correct selection of diagnostic imaging techniques. Biliptysis is the pathognomonic physical finding of bronchobiliary fistulas. Demonstration of high bilirubin levels in the pleural effusion is diagnostic for a pleuro-biliary fistula. The optimal treatment of bronchobiliary fistulas is operative, in order to prevent their dramatic consequences. For pleurobiliary fistulas, a light aggressive conservative approach is an appealing option in the beginning. Newer endoscopic techniques increase the non-operative approach.