Bronchobiliary fistula – a rare complication of hepatic endometriosis Endometriose

We report the case of a 39 year old woman with an external endometriosis being evident with hemoptysis before pregnancy and bilioptysis 7 days after the vaginal delivery. In bronchoscopy, biliary sputum in the right basal lobe was seen. Staging was completed by MR-scan showing a bronchobiliary fistula. A one-stage operation for the hepatic and pulmonary lesions was performed through a transdiaphragmatic approach via laparotomy. We report this case to emphasize that the first-line treatment for a bronchobiliary fistula caused by endometriosis is radical surgery, resulting in relief of symptoms with excellent clinical result. Histopathological analyses confirmed the presence of clusters of endometrial glands embedded in decidual stroma which were neighboring the liver while perifistulous lung tissue was shown to contain biliary pigment absorbed by macrophages and their derivatives.