An innovative surgical approach using the hepatic falciform ligament to repair bronchobiliary fistula after radiofrequency ablation: a case report.

Background: Bronchobiliary fistula (BBF), an abnormal connection between the biliary ducts and bronchus, is often caused by liver malignancy, biliary obstructive disease, liver locoregional treatment, or surgery. Although rare, BBF is associated with a high mortality rate in the absence of invasive treatment. Case Description: This report describes a patient with intrahepatic cholangiocarcinoma (ICC) who developed a hepatic abscess following repeated radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and targeted therapy. The abscess extended transdiaphragmatically, leading to empyema, a lung abscess, and BBF. The patient exhibited high fever and productive cough with bile-like sputum. Computed tomography (CT) imaging revealed a liver abscess at the junction of the liver lobes, consolidation of the right middle lobe of the lung, and right-sided pleural effusion. Surgical debridement and diaphragmatic repair were performed after conservative treatment failed. The abscess cavity was closed, drained, and covered with the round ligament and falciform ligament of the liver to eliminate the fistula. The patient recovered well postoperatively, and the drainage tube was removed 1 month later without significant complications. Conclusions: This case highlights a novel, minimally invasive, and effective surgical technique for treating BBF post-RFA, potentially reducing mortality and improving recovery in patients intolerant of extensive thoracoabdominal procedures.