Biliopleural Fistula as a Late Complication of Percutaneous Transhepatic Cholangioscopy

Meester, X. De; Vanbeckevoort, Dirk; Aerts, R; Steenbergen, Werner Van

doi:10.1055/s-2004-826189

Cited by 14 publications

(10 citation statements)

References 5 publications

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“…Percutaneous transhepatic biliary drainage is often used in treatment of obstructive biliary disease to relieve symptoms prior to surgery or palliatively in patients who are poor candidates for surgery [ 1 ]. Biliopleural fistula is a rare complication following this procedure, which may be due to the passage of catheter through the pleural cavity before crossing the diaphragm and into the bile duct when a transhepatic approach is used [ 1 , 5 - 7 ]. Elevated pressure gradient in the biliary tract could drive the bile leak back into the pleural cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that fistula formation occurs within 3 weeks of catheter placement and biliopleural effusion may develop when the catheter remained in bile duct for more than 4 weeks [ 1 ]. One study revealed common features that lead to the development of the BF: (i) Complete biliary obstruction was present; (ii) Catheter placement was between the 9th and 10th ribs in the midaxillary line; (iii) prolonged drainage (7 days to 2 months) preceded fistula formation [ 7 ]. These features are also seen in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…These features are also seen in our patient. Another study suspected the path created by the large drainage tubes served as an ideal passage through which bile could leak back into the pleural cavity in the presence of persistent biliary tract obstruction [ 7 ]. Bilious fluid collections can be present anywhere along the path of the PTBD catheter from the biliary tree to the pleural space [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The direct tract from the skin to the pleura without true pleural drainage could predispose to pleural seeding with bacterial pathogens [ 1 ]. The incidence of cholangitis in patients with completely obstructed and dilated biliary tracts is high (> 80%) without clinical symptoms [ 7 ]. The patient should be evaluated for empyema if a BF develops.…”

Section: Discussionmentioning

confidence: 99%

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Late onset of biliopleural fistula following percutaneous transhepatic biliary drainage: a case report

Yu¹,

Chiu²,

Tsai³

et al. 2018

BioMedicine

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Biliopleural fistula (BF) and formation of biliopleural effusion is a rare complication following percutaneous transhepatic biliary drainage (PTBD). It occurs when the pleura is traversed by the catheter before entering the bile duct. Biliopleural fistula should be suspected when right side pleural effusion develops following the PTBD procedure. The diagnosis of biliopleural fistula is made when greenish pleural fluid with high concentration of bilirubin is aspirated. Here we present a case where a patient develops a biliopleural fistula following PTBD due to obstructive jaundice caused by neuroendocrine tumor of pancreas. Biliopleural fistula was disclosed after a scheduled catheter replacement procedure. Treatments of biliopleural fistula include thoracentesis with drainage tube installation into pleural space. In addition, a drainage tube was installed through percutaneous transhepatic gallbladder drainage (PTGBD) to reduce the bile induced pressure. Surgical repair of fistula was performed after the conservative treatment was unsuccessful. The patient expired 5 days after surgery due to respiratory failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Late onset of biliopleural fistula following percutaneous transhepatic biliary drainage: a case report

Yu¹,

Chiu²,

Tsai³

et al. 2018

BioMedicine

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“…However, endoscopic cholangioscopy is less invasive and does not carry the theoretical risk of tumour seeding that potentially occurs in percutaneous cholangioscopy 70 . It also avoids the formation of a permanent biliary fistula 77 when a PTC drains an obstructed segment from above. Potential complications of endoscopic drainage include cholangitis as a result of contamination of a partially drained system – mandating prophylactic antibiotics 70 – and the standards risks of endoscopy.…”

Section: Endoscopymentioning

confidence: 99%

Focal intrahepatic strictures: a review of diagnosis and management

Yeo

Perini

Muralidharan

et al. 2012

HPB

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A focal intrahepatic stricture requires thorough investigation to exclude malignancy even in patients with a history of biliary surgery, hepatolithiasis or parasitic infection. If during the investigative process a diagnosis or suspicion of malignancy is demonstrated then surgical resection should be performed. If all diagnostic modalities suggest a benign aetiology, then cholangioscopy with targeted biopsies should be performed.

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Nonoperative management of biliopleural fistula following living‐donor liver transplantation: A case report

Kazemi,

Rasekhi,

Nazari

et al. 2023

Clinical Case Reports

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Key Clinical MessageBiliopleural fistula is a rare but serious complication after liver transplantation that should be managed nonoperatively with antibiotics, pleural drainage, decompression of high‐pressure biliary tract, or ultimately surgery in unresponsive cases.AbstractBilious pleural effusion is a rare entity often iatrogenic, following hepatobiliary surgeries and biliary interventions, and has been reported only in a limited number of patients after liver transplantation. A 5‐year‐old girl underwent living donor liver transplantation due to progressive familial intrahepatic cholestasis. At the 7th day of the postoperative course, due to increased liver enzymes and bilirubin levels and intrahepatic bile duct dilatation on sonography, Magnetic Resonance Cholangiopancreaticography followed by a liver biopsy were performed; the findings demonstrated moderate intrahepatic bile duct dilatation and moderate cellular rejection associated with mild cholestasis, respectively. The patient was therefore administered a pulse of methylprednisolone; however, due to fever, peritonitis and also sonographic evidence of infected biloma collection adjacent to the transplanted liver, the patient underwent surgery. Laparotomy and peritoneal washout were performed and a Jackson‐Pratt drain was inserted adjacent to the liver cut surface. Succeeding tachypnea on 28th post day, led to detection of right side massive pleural effusion on chest Xray and hence thoracostomy tube was inserted. A diagnosis of biliopleural fistula was established and broad‐spectrum intravenous antibiotic therapy was started, followed by cholangiography, fistula closure, and bile duct stricture ballooning and internal‐external biliary catheter insertion. The patient was discharged in generally good condition on the 50th posttransplant day. The diagnosis of biliopleural fistula is facilitated with the utilization of chest imaging and pleural fluid analysis, however, a high index of suspicion is required.

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Biliopleural Fistula as a Late Complication of Percutaneous Transhepatic Cholangioscopy

Abstract: References1 Carrasco CH, Zornoza J, Bechtel WJ. Malignant biliary obstruction: complica

Cited by 14 publications

References 5 publications

Late onset of biliopleural fistula following percutaneous transhepatic biliary drainage: a case report

Late onset of biliopleural fistula following percutaneous transhepatic biliary drainage: a case report

Focal intrahepatic strictures: a review of diagnosis and management

Nonoperative management of biliopleural fistula following living‐donor liver transplantation: A case report

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