Abstract | BACKGROUND: Thoracobiliary fistulas are rare manifestations of biliary disruption. Given their rarity it is not surprising that there is little consensus on the optimal management of thoracobiliary fistulas. METHODS: Patients presenting with thoracobiliary fistulas over a 5-year period (1996 to 2001) were evaluated. Initial management was conservative with tube thoracostomy or drainage of sepsis when appropriate, or both; antibiotics and somatostatin were routinely administered. Endoscopic retrograde cholangiography was performed when symptoms persisted to delineate the thoracobiliary communication and undertake sphincteroplasty. RESULTS: Eight patients with a mean age of 31.9 years (range 15 to 42) were evaluated. Biliary effusion occurred in 3 patients after hepatic injury (n = 2) and percutaneous transhepatic cholangiography (n = 1). Bilioptysis occurred in 5 patients after hepatic abscess (n = 4) and hepatic injury (n = 1) The biliary effusion (n = 3) was successfully managed by endoscopic sphincterotomy in 2 patients; the third patient underwent urgent surgical biliary drainage. Bilioptysis (n = 5) was successfully managed in 3 patients; persistence of symptoms in 2 patients prompted surgical intervention. CONCLUSIONS: Thoracobiliary fistulas may be successfully managed using a conservative approach. Surgery should be reserved for persistence of symptoms after exhaustion of this approach.
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Authors | Bhugwan Singh, Jaynathan Moodley, Mohamed H Sheik-Gafoor, Naseem Dhooma, Anunathan Reddi |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 73
Issue 4
Pg. 1088-91
(Apr 2002)
ISSN: 0003-4975 [Print] Netherlands |
PMID | 11996246
(Publication Type: Journal Article)
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Topics |
- Adolescent
- Adult
- Biliary Fistula
(diagnosis, etiology, therapy)
- Cholangiography
(adverse effects)
- Cholangiopancreatography, Endoscopic Retrograde
- Female
- Humans
- Liver
(injuries)
- Liver Abscess, Amebic
(complications)
- Male
- Respiratory Tract Fistula
(diagnosis, etiology, therapy)
- Sphincterotomy, Endoscopic
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