Introduction: Bilio-bronchial fistula of hydatid origin is a rare but serious complication of hepatic hydatid cyst, the treatment of which is now well established.
Case report: We report a case of bilateral bilio-bronchial fistula, successfully managed by bilateral thoracotomy with an interval of one week, and complicated by dyspnoea that resolved quickly.
Conclusion: If the indication for thoracotomy is indisputable in case of unilateral bilio bronchial fistula, an initial laparotomy should be considered in the case of bilateral bilio-bronchial fistula.