Bronchobiliary and bronchopleural fistulas.

In the course of treating approximately 2,000 patients with postoperative stricture of the bile duct, 16 bronchopleural and bronchobiliary fistulas were encountered. Three patients have been seen in the past year. This has prompted a review of our experience since it was previously recorded in 1955. Fistulous complications of obstructive biliary tract disease take three forms: (1) massive fulminating biliary empyema; (2) acute necrotizing bile bronchiolitis and pneumonia when pleural symphysis exists; and (3) a more indolent, chronic, recurring form of bronchobiliary communication. We have learned that transdiaphragmatic perforation occurs at a certain characteristic location in the diaphragm. An understanding of the pathological anatomy and pathogenesis has provided a specific and sequential mode of surgical treatment. When this has been adhered to strictly, cure has resulted.