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Dao DT, Le TH, Tran MT, Tran HH, Tran VH, Huynh TA. Bilothorax as a complication of endoscopic retrograde cholangiopancreatography: A rare case report and literature review. Int J Surg Case Rep 2024; 122:110059. [PMID: 39059236 DOI: 10.1016/j.ijscr.2024.110059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/13/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Bilothorax is a rare and poorly documented condition in the medical literature, with following hepatobiliary procedures being the most common cause. We present a case of bilothorax following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. CASE PRESENTATION A 71-year-old woman with a history of prior percutaneous biliary stone removals presented with Charcot's triad and was diagnosed with cholangitis due to a distal common bile duct stone. She underwent ERCP with successful stone extraction and stent placement. Two days later, she developed a right-sided pleural effusion diagnosed as a post-ERCP bilothorax. She was treated with thoracentesis and antibiotics, and her condition significantly improved. After 15 days, she was discharged, and a one-month follow-up showed no complications or recurrence. CLINICAL DISCUSSION Bile is a potent chemo irritant that can cause adhesive pleurodesis. Besides, accompanying cholangitis can lead to pleural infection and empyema. In this patient, early diagnosis leading to timely pleural drainage decisions helped avoid potential consequences. CONCLUSION Post-ERCP bilothorax is a rare complication but can lead to severe consequences. Nonoperative management by pleural drainage is a safe and effective strategy if diagnosis is made early, helping patients avoid more invasive interventions.
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Affiliation(s)
- Duc Tien Dao
- Oncology and Nuclear Medicine Center, Military Hospital 175, Ho Chi Minh City, 70000, Viet Nam
| | - Trung Hieu Le
- Department of Hepato-Biliary-Pancreatic Surgery, Institute of Digestive Surgery, Military Central Hospital 108, Hanoi 10000, Viet Nam.
| | - Manh Thang Tran
- College of Health Sciences, VinUniversity, Hanoi 113000, Viet Nam
| | - Ha Hieu Tran
- Department of Gastroenterology, Military Hospital 175, Ho Chi Minh City 70000, Viet Nam
| | - Van Hieu Tran
- Department of Gastroenterology, Military Hospital 175, Ho Chi Minh City 70000, Viet Nam
| | - Tan Ai Huynh
- College of Health Sciences, VinUniversity, Hanoi 113000, Viet Nam
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Acharya R, Kafle S, Sedhai YR, Shrestha DB, Walsh K, Shamsi WE, Gyawali S, Acharya N, Loschner AL, Rubio ER. Bilothorax: A Case Report and Systematic Literature Review of the Rare Entity. Pulm Med 2024; 2024:3973056. [PMID: 38947176 PMCID: PMC11213635 DOI: 10.1155/2024/3973056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/14/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
Background Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid-to-serum bilirubin ratio of >1. Methods The PubMed, Embase, Google Scholar, and CINAHL databases were searched using predetermined Boolean parameters. The systematic literature review was done per PRISMA guidelines. Retrospective studies, case series, case reports, and conference abstracts were included. The patients with reported pleural fluid analyses were pooled for fluid parameter data analysis. Results Of 838 articles identified through the inclusion criteria and removing 105 duplicates, 732 articles were screened with abstracts, and 285 were screened for full article review. After this, 123 studies qualified for further detailed review, and of these, 115 were pooled for data analysis. The mean pleural fluid and serum bilirubin levels were 72 mg/dL and 61 mg/dL, respectively, with a mean pleural fluid-to-serum bilirubin ratio of 3.47. In most cases, the bilothorax was reported as a subacute or remote complication of hepatobiliary surgery or procedure, and traumatic injury to the chest or abdomen was the second most common cause. Tube thoracostomy was the main treatment modality (73.83%), followed by serial thoracentesis. Fifty-two patients (51.30%) had associated bronchopleural fistulas. The mortality was considerable, with 18/115 (15.65%) reported death. Most of the patients with mortality had advanced hepatobiliary cancer and were noted to die of complications not related to bilothorax. Conclusion Bilothorax should be suspected in patients presenting with pleural effusion following surgical manipulation of hepatobiliary structures or a traumatic injury to the chest. This review is registered with CRD42023438426.
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Affiliation(s)
- Roshan Acharya
- Division of Pulmonary and Critical Care MedicineVirginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Smita Kafle
- Department of Family Nurse PractitionerFrontier Nursing University, Versailles, KY, USA
| | - Yub Raj Sedhai
- Division of Pulmonary and Critical Care MedicineUniversity of Kentucky, Bowling Green, KY, USA
| | | | - Kevin Walsh
- Division of Pulmonary and Critical Care MedicineVirginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Wasif Elahi Shamsi
- Division of Pulmonary and Critical Care MedicineVirginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Suraj Gyawali
- Department of Emergency MedicineGrande International Hospital, Kathmandu, Nepal
| | - Nikita Acharya
- Department of Internal MedicineUniversal College of Medical Sciences, Siddharthanagar, Nepal
| | - Anthony Lukas Loschner
- Division of Pulmonary and Critical Care MedicineVirginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Edmundo Raul Rubio
- Division of Pulmonary and Critical Care MedicineVirginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Ravikumar DB, Sivasubramanian BP, Dominic Savio FV, Gunendran T, Shekar SP. A Green Surprise: Bilateral Bilious Pleural Effusion Secondary to Esophageal Rupture-A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096241231634. [PMID: 38361358 PMCID: PMC10870808 DOI: 10.1177/23247096241231634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/07/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
Bilothorax, an exudative pleural effusion due to the accumulation of bile. It is also called cholethorax or thoracobilia and was initially reported in 1971. Here, we report a rare case of an elderly male presenting with bilateral bilothorax due to esophageal rupture. A 78-year-old man with multiple medical ailments presented to the emergency room (ER) with a severe episode of vomiting accompanied by a popping sound, respiratory distress, and right sided chest pain. The patient had tachycardia, BP of 101/89 mm Hg, and tachypnea. Computed tomography scan of the chest and abdomen revealed air adjacent to the esophagus, suggesting perforation, atelectasis of right lung, and bilateral pleural effusion (R > L). However, an esophagram did not reveal any perforation. Right-sided chest tube drained dark green bilious fluid. The day after admission, he experienced hemodynamic compromise and hypoxemia requiring intubation, along with fluids and inotropes support. Diagnosis of bilateral bilothorax complicated by hypoxemic respiratory failure with septic shock was made. Cultures were drawn, and empiric antibiotics were started. Nuclear hepatobiliary scan (HIDA) was performed to rule out a hepatobiliary fistula. Results showed reflux activity in the stomach, and distal esophageal leak was identified. Gastrojejunal stenting was performed. However, after prolonged intubation, the family decided on terminal extubation, and he died while receiving hospice care. This case highlights the rarity of bilateral bilothorax, where the HIDA scan played a crucial role in identifying an esophageal leak as the underlying cause, despite normal esophagram results. This condition necessitates prompt diagnosis and aggressive therapeutic interventions.
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Kazemi K, Rasekhi A, Nazari SS, Lashkarizadeh MM, Shamsaeefar A, Alikhani M, Akbari A, Shahriarirad R. Nonoperative management of biliopleural fistula following living-donor liver transplantation: A case report. Clin Case Rep 2023; 11:e8210. [PMID: 38028040 PMCID: PMC10654471 DOI: 10.1002/ccr3.8210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Biliopleural 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. Abstract Bilious 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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Affiliation(s)
- Kourosh Kazemi
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Alireza Rasekhi
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Sahar Sohrabi Nazari
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | | | - Alireza Shamsaeefar
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Mohammad Alikhani
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Ali Akbari
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- School of MedicineShiraz University of Medical SciencesShirazIran
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
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Srivali N, De Giacomi F. Bilothorax: A Rare Complication of Gallstone Disease. Arch Bronconeumol 2021; 57:433. [PMID: 34088399 DOI: 10.1016/j.arbr.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/22/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Narat Srivali
- Division of Pulmonary Medicine (NS), St. Agnes Hospital, Baltimore, MD 21229, USA; Respiratory Unit (FG), Cremona Hospital, Cremona, Italy.
| | - Federica De Giacomi
- Division of Pulmonary Medicine (NS), St. Agnes Hospital, Baltimore, MD 21229, USA; Respiratory Unit (FG), Cremona Hospital, Cremona, Italy
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Srivali N, De Giacomi F. Bilothorax: A Rare Complication of Gallstone Disease. Arch Bronconeumol 2020. [PMID: 33127200 DOI: 10.1016/j.arbres.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Narat Srivali
- Division of Pulmonary Medicine (NS), St. Agnes Hospital, Baltimore, MD 21229, USA; Respiratory Unit (FG), Cremona Hospital, Cremona, Italy.
| | - Federica De Giacomi
- Division of Pulmonary Medicine (NS), St. Agnes Hospital, Baltimore, MD 21229, USA; Respiratory Unit (FG), Cremona Hospital, Cremona, Italy
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Iatrogenic Bilothorax: A Rare Complication of Orthotopic Liver Transplant. ACG Case Rep J 2019; 6:e00137. [PMID: 31620534 PMCID: PMC6722382 DOI: 10.14309/crj.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/10/2019] [Indexed: 11/24/2022] Open
Abstract
Bilothorax is a rare condition involving drainage of bile from the biliary system into the lung's pleural space. Several cases have been reported in the literature, where the most commonly reported cause is iatrogenic injury. To date, no cases of bilothorax as a complication of liver transplantation have been reported. Given its rarity and concurrent morbidity, early recognition is paramount as this condition can quickly deteriorate into adult respiratory distress syndrome.
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Shah K, Ravikumar N, Uddin QK, McGee W, Farmer MJS. Bilateral Bilothorax: An Unusual Cause of Bilateral Exudative Pleural Effusion. Cureus 2019; 11:e5185. [PMID: 31565594 PMCID: PMC6758986 DOI: 10.7759/cureus.5185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Bilothorax is an uncommon cause of exudative pleural effusion; the majority of reported cases are right-sided while a bilateral presentation is extremely rare. The majority of cases are secondary to biliary obstruction, an extension of hepatic infections, and iatrogenic complications following percutaneous procedures or surgical interventions. Imaging studies and a diagnostic pleural tap can confirm the diagnosis. Early recognition and complete drainage are important to prevent life-threatening complications, including empyema formation. We present a case of a 71-year-old female who developed bilateral bilothorax as a complication of gallstone pancreatitis.
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Affiliation(s)
- Kanval Shah
- Internal Medicine, University of Massachusetts Medical School - Baystate Medical Center, Springfield, USA
| | - Nakul Ravikumar
- Pulmonary and Critical Care, University of Massachusetts Medical School - Baystate Medical Center, Springfield, USA
| | - Q Kamran Uddin
- Critical Care, University of Massachusetts Medical School - Baystate Medical Center, Springfield, USA
| | - William McGee
- Critical Care, University of Massachusetts Medical School - Baystate Medical Center, Springfield, USA
| | - Mary Jo S Farmer
- Pulmonary and Critical Care, University of Massachusetts Medical School - Baystate Medical Center, Springfield, USA
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Sano A, Yotsumoto T. Bilothorax as a complication of percutaneous transhepatic biliary drainage. Asian Cardiovasc Thorac Ann 2015; 24:101-3. [PMID: 26294694 DOI: 10.1177/0218492315603214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report two cases of bilothorax that occurred as a complication of percutaneous transhepatic biliary drainage. In an 86-year-old woman who had undergone percutaneous transhepatic biliary drainage for obstructive jaundice, bilothorax occurred after accidental removal of the tube. She recovered with chest drainage only. An 83-year-old man who had undergone percutaneous transhepatic biliary drainage for cholecystitis developed bilothorax with infection. He recovered with thoracoscopic curettage. Although bilothorax is a rare complication of percutaneous transhepatic biliary drainage, appropriate diagnosis and prompt treatment is important, especially when bilothorax is accompanied by infection.
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Affiliation(s)
- Atsushi Sano
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Japan
| | - Takuma Yotsumoto
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Japan
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