WOFAPS 2025 8th World Congress of Pediatric Surgery

Mohamed Helali ¹, Isam Taha ¹, Maher yousef ²

¹ National Ribat University Hospital
² King Salman Hospital, Ministry of Health, Riyadh, Saudi Arabia.

Introduction:

Congenital bronchobiliary fistula (CBBF) is an extremely rare anomaly, first described in 1952. We report the first documented case in Sudan, highlighting diagnostic challenges and the significance of clinical suspicion in infants with bilious respiratory symptoms.

Case Presentation:

An 11-month-old female presented with a chronic cough productive of copious yellowish sputum since the neonatal period, initially misdiagnosed as pneumonia and pertussis. Despite multiple antibiotic regimens, symptoms continued. Key findings included yellow-stained sputum/tongue, respiratory distress, and MRCP demonstrating a 2–5 mm fistulous tract between the left hepatic lobe and right main bronchus. HIDA scan was negative. Laparotomy with intraoperative cholangiography confirmed the fistula, which was adequately ligated. Postoperative course went uneventfully with complete resolution of symptoms.

Conclusion:

CBBF needs high clinical suspicion, specially in infants with bilious sputum and refractory respiratory symptoms. MRCP is critical for diagnosis when conventional tests (e.g., HIDA scan) are inconclusive. The definitive treatment remains surgical repair. This case emphasizes the need for awareness of rare anomalies in differential diagnoses to avoid delayed management.

Conflict of Interest:

The authors declare no conflict of interest.