Bilothorax: A Bitter Complication of Liver Surgery

Hamers, L. A. C.; Bosscha, K.; Leuken, Maarten H van; Moviat, Miriam; Jager, Cornelis P.C. de

doi:10.1155/2013/372827

Cited by 9 publications

(19 citation statements)

References 5 publications

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“…Bile leakage into the pleural space can occur directly from the biliary tree through diaphragmatic defects or via the lymphatic system in the case of concurrent biliary peritonitis (choleperitoneum). In people, bile pleuritis is mostly associated with surgery involving the biliary system or trauma . In companion animals, bile pleuritis has been reported in a few cases as complication of cholecystectomy, after penetrating thoracic injuries and secondary to a presumptive lesion created by a thoracotomy tube placement in a cat with pyothorax …”

Section: Discussionmentioning

confidence: 99%

What is your diagnosis? Pleural effusion in a dog with a gunshot wound

Bartolini

Iudica²,

Torti³

et al. 2015

Veterinary Clinical Pathol

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A 3-year-old male cross-breed dog was presented with a one-day history of prostration. The dog lived in-and outdoors, was routinely vaccinated, and under heartworm prophylaxis. Physical examination revealed lethargy, depression, hypothermia (37.5°C), dyspnea, and jaundiced mucous membranes. A CBC showed mild thrombocytopenia (154,000 platelets/lL, reference interval [RI] 190,000-470,000/lL). A blood chemistry profile showed marked increase in liver enzyme activity (ALP 7640 IU, RI 0-180 IU; GGT 22 IU, RI 0-10 IU; ALT 260 IU, RI 0-110; AST 98 IU, RI 0-90 IU), moderate hyperbilirubinemia (4.65 mg/dL, RI 0-0.6 mg/dL), and moderate hyperglycemia (301 mg/dL, RI 80-130 mg/dL). Thoracic radiographs revealed moderate bilateral pleural effusion. Abdominal radiography showed the presence of an air gun pellet in the subcutis of the hypochondrium. Thoracocentesis was performed and yielded a brownish fluid characterized by a total nucleated cell count (TNCC) of 42,000/lL and a RBC count of 51,000/lL ( Figure 1). After centrifugation of the fluid at 100g, the supernatant color was the same as in the native effusion sample, and the total protein concentration was 3.1 g/dL. Smears from the sediment were made and stained with May-Gr€ unwald-Giemsa (MGG) and DiffQuick (Figures 2 and 3). Figure 3. Thoracic fluid, centrifuged preparation. Amorphous mucinous material with embedded inflammatory cells. Diff-Quick. 910 objective.Figure 1. Appearance of pleural effusion just after collection.Figure 2. Microscopic pattern of pleural fluid on sediment smear after concentration. May-Gr€ unwald-Giemsa. 9100 objective.

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Section: Discussionmentioning

confidence: 99%

What is your diagnosis? Pleural effusion in a dog with a gunshot wound

Bartolini

Iudica²,

Torti³

et al. 2015

Veterinary Clinical Pathol

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“…Liver abscess or subdiaphragmatic abscess are the common entities causing pleural effusion, but biloma with a fistulous communication with pleural space as an etiology of pleural effusion is extremely uncommon in the published literature. [ 1 3 ] Bilothorax can be iatrogenic or even rarely spontaneous. Laparoscopic or open surgical procedures of the hepatobiliary tree or blunt trauma are among the few causes of iatrogenic bilothorax.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic or open surgical procedures of the hepatobiliary tree or blunt trauma are among the few causes of iatrogenic bilothorax. [ 3 4 5 6 7 8 ] On rare occasions, spontaneous bilio-pleural fistula can occur in patients with gall stones. [ 9 ] Rarely bile can reach directly to the bronchial tree by means of a broncho-biliary fistula and results in bilioptysis.…”

Section: Discussionmentioning

confidence: 99%

“…The proposed mechanism of formation of pleurobiliary fistula following injury to the biliary tree is formation of biloma and subsequent rupture of the biloma into the pleural cavity through the transdiaphragmatic route following the path of least resistance. [ 3 11 ] Passage of the bile through the connective tissue sheath of esophagus and great vessels to reach the posterior mediastinum and subsequent spillage from there into the pleural cavity or bronchus has been postulated as another theory for thoraco-biliary fistulas. [ 3 ]…”

Section: Discussionmentioning

confidence: 99%

“…Bilious pleural effusion is an extremely rare cause of pleural effusion. [ 1 2 ] It usually occurs after surgical exploration of the biliary tree,[ 3 4 ] but traumatic disruption of hepatobiliary system leading to bilothorax is also reported in the literature. [ 2 ] Irrespective of the etiology, thoraco-biliary fistulous and bilothorax put the clinicians in diagnostic as well as therapeutic dilemma.…”

Section: Introductionmentioning

confidence: 99%

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A rare pleural effusion in a young male

et al. 2015

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A 28-year-old male presented with fever with right-sided chest pain for 2 weeks. Clinicoradiological picture was suggestive of right-sided pleural effusion. He had history of polytrauma following a road traffic accident and had to undergo emergency laparotomy a month ago. Microscopic and culture examination of the pleural fluid showed neutrophilia, high bilirubin content and presence of gram-negative bacilli. Ultrasound of the abdomen showed the presence of biloma in the liver and right subdiaphragmatic space with fistulous communication into the right thoracic cavity. The patient was managed successfully with complete recovery.

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Biliary complications post liver resection for pediatric liver tumors

Othman¹,

Teh²,

Zahari³

2023

World Jnl Ped Surgery

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ObjectiveTo review biliary complications following liver resection for liver tumors in children and their associated risk factors.MethodsRetrospectively, we reviewed children who underwent liver resection for liver tumors from 2010 to 2019. Demographic data, operative details, types of complications, interventions and outcomes were studied.ResultsEighty-six out of 108 liver resections were included in this study. The median age of patients was 1.8 years old, and 55% were male. The majority (95%) were malignant tumors, of which 87% were hepatoblastoma (n=71). The most common procedure performed was extended right hepatectomy (37%, n=32). Twelve (14%) patients had primary biliary complications: nine bile leakages and three biliary obstructions. Six cases of bile leakage were treated non-operatively with drainage only; however, one developed bilothorax. Three bile leakages underwent early operative intervention. Four patients underwent biliary reconstruction. Biliary complications were not significantly associated with age, sex, ethnicity or pathology of the tumor. Ten of them (83%) developed following extended hepatectomies (five right, five left), in which the left side had a higher rate of complications (63% vs 16%). None of the central hepatectomies had biliary complications. Biliary complication rates were significantly higher among those who had segmentectomy 1 (p=0.023).ConclusionsBiliary complication is a significant morbidity following liver resection in children. Surgery is eventually required for complicated bile leakage and primary biliary strictures. Follow-up is mandatory since secondary biliary complications may occur after the initial resolution of bile leakage. The groups at high risk of developing biliary complications are extended left hepatectomies and segmentectomy 1.

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Bilothorax: A Bitter Complication of Liver Surgery

Cited by 9 publications

References 5 publications

What is your diagnosis? Pleural effusion in a dog with a gunshot wound

What is your diagnosis? Pleural effusion in a dog with a gunshot wound

A rare pleural effusion in a young male

Biliary complications post liver resection for pediatric liver tumors

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