Demonstration of a biliobronchial fistula with a hepatoiminodiacetic acid scan

Biliobronchial fistula (BBF) is a rare complication after hepatic resection. A 68-year-old woman who had undergone a right hepatic trisegmentectomy followed by a hepaticojejunostomy with a Roux-en-Y anastomosis for gallbladder cancer and liver metastasis from colon cancer was admitted to our hospital for further investigation of persistent bilioptysis. We could not detect the cause of the bilioptysis on computed tomography or magnetic resonance cholangiopancreatography, but a hepatoiminodiacetic scan clearly showed the BBF. Endoscopic retrograde cholangiography is thought to be suitable for diagnosing BBF, but it is invasive and unavailable in patients who have undergone digestive reconstruction, such as a Roux-en-Y anastomosis. In such cases, hepatoiminodiacetic scanning should be used for diagnosing BBF.