Fístula biliopleural postraumática: serie de casos de una complicación muy poco frecuente

Abstract

Background: Pleurobiliary fistula is a rare complication of thoraco-abdominal trauma that is confirmed by the presence of bilirubin in pleural fluid. Objective: The aim of this study is to analyze the management and treatment performed to patients with pleurobiliary fistula due to penetrating thoracoabdominal injury and their results, compare them with the published literature, and propose a treatment algorithm. Material and methods: For this descriptive and retrospective study, we reviewed 5688 medical records of patients admitted to Hospital José María Cullen, Santa Fe, Argentina, Centro de Trauma Nivel 1 between January 2010 and January 2016; 614 had involvement of the thoracic and abdominal region. The demographic data, kinematics of trauma, diagnosis, treatment and patient progress were analyzed. Results: Seven cases of pleurobiliary fistula were found. All the patients were men with penetrating trauma. Pleural drainage was the initial treatment in 4 cases, 2 patients underwent pleural drainage and exploratory laparotomy and 1 patient underwent urgent thoracotomy. Two cases resolved with pleural drainage alone. Five patients require biliary drainage through endoscopic retrograde cholangiopancreatography with sphincterotomy. Two of these patients also required biliary stenting and 2 also underwent percutaneous drainage. Finally, 2 patients required thoracotomy, 1 of them with open pleurostomy. The fistulae resolved in all the cases with acceptable morbidity. None of them died. Conclusion: In current surgical practice, the wide availability of interventional endoscopy has improved the minimally invasive approach for the management of PBF. Surgical management should be limited to fistulae not responding lo less invasive treatments or to complicated fistulae.