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Rare case of Bilio-thorax as unrecognized complication of liver surgery- A report

Written By : Dr. Nandita Mohan |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-12-08T19:09:56+05:30  |  Updated On 9 Dec 2020 2:54 PM IST
Rare case of Bilio-thorax as unrecognized complication of liver surgery- A report
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Dr Asad Ali Kerawala and Abid Jamal from the Cancer Foundation Hospital, Karachi, Pakistan recently reported an unusual case of Bilio-thorax which was an unrecognized complication of liver surgery.

The case report has been published in the International Journal of Surgery Case Reports.

Fistulas between the biliary tree and the chest have been a reality after liver surgery. Most of them present as pleural effusions, however, cases of bronchial fistula are also not unheard of. Although a rare complication, Biliothorax, or chole-thorax as it has been called in literature, is a devastating entity if not recognized early. Various causes have been reported for biliothorax like inflammatory, abdominal trauma, neoplastic, the most frequent being percutaneous hepatic intervention.
Physicians who have a high index of suspicion usually diagnose this before any harm is done but at times it is diagnosed too late and the patient suffers. Therefore, the authors studied the case of a 60-year-old man who presented for a routine follow-up and reversal of his stoma.

The patient was treated for colon cancer, who developed this complication after liver surgery when he reported back after 7 days with dyspnea and fever for 1 day. The patient kept draining 300 mL, 250 mL of bile per day for 7 days. No abdominal collection was found. An ERCP and sphincterotomy were planned but the sphincter was in spasm and a sphincterotomy could not be performed fully.
The drainage eventually stopped, and the chest tube was removed on the 23rd day. The reason was probably the fact that the bile leak collected and because of no presence of drain in the abdomen, it made its way in the Pleural cavity through the pleuroperitoneal canal. Another cause could be a diaphragmatic injury which was not identified per operatively, but there was no pneumothorax to suggest that, describes Kerawala.
The researchers further discussed that although a rare complication, Biliothorax, is a fatal complication if missed. The presence of bile in the pleural cavity is damaging and can lead to empyema, entrapped lung, and even ARDS. Hence it is imperative to recognize early, find the cause, and treat it appropriately.
They, therefore, concluded that "biliothorax is an under-reported complication of liver surgery which can have disastrous effects on the patient leading to morbidity and even mortality. It is vital to recognize it early and treat accordingly."
For further reference, log in to:
https://doi.org/10.1016/j.ijscr.2020.04.080


Bilio-thoraxPleural effusionliver resectiononcologySurgeryTube thoracostomyInternational Journal of Surgery Case Reports
Source : International Journal of Surgery Case Reports
Dr. Nandita Mohan
Dr. Nandita Mohan

    Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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