Background:Post-hepatectomy bile leaks are significant causes of morbidity and may rarely progress to complex fistulas, including uncommon bronchobiliary fistulas.

Case: A 52-year-old developed a post operative bile leak with a biloma and a biliobronchial fistula. Initial ERCP with sphincterotomy, stenting, and nasobiliary drainage failed to reduce output (>500 mL/day), leading to repeat ERCPs with additional drainage and stents placement. Persistent leakage required percutaneous and IR intervention, including transhepatic access, tract dilation, and closure with an 18-mm vascular plug and a glue. A 12-Fr pigtail drain was left for controlled biloma drainage.

Conclusion: A hybrid endoscopic–percutaneous–IR strategy successfully treated this rare post-hepatectomy bronchobiliary fistula.