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Background Bronchobiliary fistula is an infrequent but severe complication following microwave ablation for hepatic malignancy. This study aims to enhance the understanding and management of BBF. Methods From November 2015 to September 2023, nine patients diagnosed with BBF following microwave ablation for hepatic malignancy were treated at the Shanghai Eastern Hepatobiliary Surgery Hospital. The clinical, diagnostic, and treatment characteristics were analyzed. Results Biliptysis was presented in 100% of the patients. Fever occurred in 77.8% of the patients. Only two patients underwent bilirubin tests for pleural fluid and one patient for sputum all of which returned positive results. All the patients had pneumonia and pleural effusion. A fistula connecting the biliary lesion to the lung was only revealed on MRI in one patient. Other findings included hepatic abscess biloma and subphrenic fluid collection. All patients underwent minimally invasive procedures such as pleural drainage (5/9) percutaneous transhepatic cholangial drainage(5/9) endoscopic nasobiliary drainage (5/9) and endoscopic retrograde biliary drainage (2/9). Only one patient underwent surgical intervention after other minimally invasive interventions failed. Among the patients three achieved a complete cure as evidenced by the complete disappearance of symptoms including coughAnd biliptysis, And they remain alive to date. Three patients witnessed An improvement in their symptoms, with a notable reduction in manifestations such as cough and biliptysis. Regrettably, they later succumbed to liver cancer. Three patients still had repeated biliptysis symptom after minimally invasive interventions and died from 2 months to 11months after the appearance of biliptysis. Conclusion Bronchobiliary fistula is a rare but serious complication of microwave ablation for hepatic malignancy, marked by biliptysis as a key symptom. Sputum bilirubin testing offers a simple diagnostic tool. Minimally invasive treatments like percutaneous transhepatic cholangial drainage and endoscopic nasobiliary drainage are effective, while surgery may be needed for refractory cases. Early intervention improves outcomes.