1870 Chest Tube Protrusion Into the Gastric Cavity Resulting in Biliary Drainage

Abstract

INTRODUCTION: Biliary drainage through a chest tube is a rare clinical finding that might be caused by Biliothorax or inadvertent penetration of the chest tube to the esophagus or the proximal stomach wall. We present a 63-year-old male patient who underwent Ivor Lewis esophagogastrectomy with his post procedural course complicated by chest tube migration and protrusion into the stomach cavity through gastropleural fistula. CASE DESCRIPTION/METHODS: A 63-year-old male patient who underwent Ivor Lewis esophagogastrectomy for distal esophageal adenocarcinoma, his clinical course was complicated by left sided pleural effusion and pneumothorax for which a chest tube was inserted. The patient clinical condition was stabilized and was discharged to an inpatient rehabilitation facility with the chest tube. Twenty days after discharge, the patient started to have bilious drainage through his chest tube again. He was admitted to hospital, imaging showed recurrent left pleural effusion. EGD was performed and showed chest tube protrusion into the stomach cavity through a gastropleural fistulas near the gastroesophageal junction. The chest tube was retracted and the gastropleural fistula was closed with over-the-scope clips. Bilious output stopped and the chest tube was removed with no further leakage. DISCUSSION: Biliary drainage through a chest tube is a rare clinical entity. It is highly suggestive of an esophageal leakage from a procedural complication. Gastropleural fistulae are rare and often occur as a complication of gastroesophageal surgery. When present, hardware, such as a chest tube, can be trapped into them resulting in various presentations. Endoscopic closure with over-the-scope clips may represent an effective and less invasive technique to close post procedural fistula tracts.