Biliary Cardiac Tamponade as a Result of Iatrogenic Biliary-Pericardial Fistula

Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review

“…Biliary pericardial effusion is a rare form of pericardial effusion that occurs in patients with predisposing conditions, such as surgical manipulation of the chest/abdominal content or penetrating trauma that establishes a fistula between the biliary tree and the pericardium [ 3 - 5 ]. The report of biliary effusion in the pericardial space in the absence of these known risk factors is even exceedingly rare.…”

“…During CT-guided needle biopsy of a liver mass, puncture of the pericardium precipitated the formation of the fistula. Lastly, additional two cases demonstrated iatrogenic intervention as the cause of biliary tamponade [ 5 , 6 ]. All previously reported cases had adequate explanations for bile accumulation in the pericardial space; our case does not have a definitive explanation even though the pericardiocentesis and the subxiphoid puncture might have injured the liver creating acute connection from a biliary duct to pericardial space.…”

An Atypical Biliary Fistula in a Liver Transplant Recipient

“…To our knowledge, this is the first case of a pericardiobiliary fistula reported as a complication of pericardiocentesis in a liver transplant recipient. There are 4 cases of pericardiobiliary fistula in the literature, 1 of which occurred after a liver biopsy, (2) 2 after penetrating abdominal trauma, (3,4) and the last in the setting of an encroaching hydatid cyst. (5) Our approach to managing this complication was with conservative measures using biliary stents to promote prograde biliary drainage along with infection control using antibiotics.…”

Pericardiobiliary fistula causing acute pericarditis and tamponade following extensive cytoreductive surgery

“…The present case is, to the best of our knowledge, the first reported case of pericardiobiliary fistula occurring following cytoreductive surgery and HIPEC. Seven other cases have been reported in the literature, in the setting of penetrating trauma, biliary stent migration, percutaneous liver biopsy, hepatic hydatid cyst, intrahepatic stones with biliary tract operation and liver transplantation . Fistula formation requires disruption of both biliary and diaphragmatic tissue.…”

“…Management of pericardiobiliary fistulae requires drainage of the biliary pericardial effusion. This may be achieved by percutaneous image‐guided pericardiocentesis with or without insertion of pericardial catheters . Concurrent antibiotic therapy is required due to high likelihood of infection.…”