Scientific letter
Posttraumatic Thoracobiliary Fistula
Fístula biliotorácica postraumática
Laura Semaan, Wilson Muñoz, David Villafañe, Carlos Enrique García Franco
Corresponding author
Unidad de Cirugia de Tórax, Departamento de Cirugía, Hospital Universitario del Valle, Cali, Colombia
Read
1137
Timeswas read the article
336
Total PDF
801
Total HTML
Share statistics
array:24 [ "pii" => "S217350772030106X" "issn" => "21735077" "doi" => "10.1016/j.cireng.2020.05.005" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "2158" "copyright" => "AEC" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Cir Esp. 2020;98:366-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0009739X19302623" "issn" => "0009739X" "doi" => "10.1016/j.ciresp.2019.08.009" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "2158" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Cir Esp. 2020;98:366-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 12 "PDF" => 12 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Fístula biliotorácica postraumática" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "366" "paginaFinal" => "367" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Posttraumatic thoracobiliary fistula" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Semaan, Wilson Muñoz, David Villafañe, Carlos Enrique García Franco" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Semaan" ] 1 => array:2 [ "nombre" => "Wilson" "apellidos" => "Muñoz" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Villafañe" ] 3 => array:2 [ "nombre" => "Carlos Enrique" "apellidos" => "García Franco" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217350772030106X" "doi" => "10.1016/j.cireng.2020.05.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217350772030106X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X19302623?idApp=UINPBA00004N" "url" => "/0009739X/0000009800000006/v1_202006050616/S0009739X19302623/v1_202006050616/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173507720301137" "issn" => "21735077" "doi" => "10.1016/j.cireng.2020.05.010" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "2157" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Cir Esp. 2020;98:368-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Parietal Recurrence of Hilar Cholangiocarcinoma: Is Percutaneous Transhepatic Biliary Drainage the Best Choice in Patients With Hiliar Cholangiocarcinoma?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "368" "paginaFinal" => "370" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recidiva parietal de colangiocarcinoma hiliar. ¿Es el drenaje biliar transparietohepático el de elección en los pacientes con colangiocarcinoma hiliar?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 855 "Ancho" => 855 "Tamanyo" => 103588 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal comupted tomography (axial view): nódule in the subcutaneous cell tissue measuring 3<span class="elsevierStyleHsp" style=""></span>cm en the right ribcage.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Clara Serrano Hermosilla, Mikel Prieto Calvo, Mikel Gastaca Mateo, Arkaitz Perfecto Valero, Andrés Valdivieso López" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Clara" "apellidos" => "Serrano Hermosilla" ] 1 => array:2 [ "nombre" => "Mikel" "apellidos" => "Prieto Calvo" ] 2 => array:2 [ "nombre" => "Mikel" "apellidos" => "Gastaca Mateo" ] 3 => array:2 [ "nombre" => "Arkaitz" "apellidos" => "Perfecto Valero" ] 4 => array:2 [ "nombre" => "Andrés" "apellidos" => "Valdivieso López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X19302611" "doi" => "10.1016/j.ciresp.2019.08.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X19302611?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507720301137?idApp=UINPBA00004N" "url" => "/21735077/0000009800000006/v1_202007030632/S2173507720301137/v1_202007030632/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173507720301071" "issn" => "21735077" "doi" => "10.1016/j.cireng.2020.05.006" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "2162" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Cir Esp. 2020;98:364-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Thoracoscopic Approach of Iatrogenic Superior Vena Cava Perforation After Dialysis Catheter Placement" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "364" "paginaFinal" => "366" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Abordaje toracoscópico de perforación iatrogénica de vena cava superior por catéter de diálisis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 623 "Ancho" => 755 "Tamanyo" => 23707 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracic CT angiogram with extravasation of the central venous catheter (arrow) and associated hemothorax.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen Sánchez Matás, Francisco Manresa Manresa, Daniel Andrades Sardiña, José Luis López Villalobos, Maria Enriqueta Bataller de Juan" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Carmen" "apellidos" => "Sánchez Matás" ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "Manresa Manresa" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Andrades Sardiña" ] 3 => array:2 [ "nombre" => "José Luis" "apellidos" => "López Villalobos" ] 4 => array:2 [ "nombre" => "Maria Enriqueta" "apellidos" => "Bataller de Juan" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X19303069" "doi" => "10.1016/j.ciresp.2019.08.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X19303069?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507720301071?idApp=UINPBA00004N" "url" => "/21735077/0000009800000006/v1_202007030632/S2173507720301071/v1_202007030632/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Posttraumatic Thoracobiliary Fistula" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "366" "paginaFinal" => "367" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Semaan, Wilson Muñoz, David Villafañe, Carlos Enrique García Franco" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Semaan" ] 1 => array:2 [ "nombre" => "Wilson" "apellidos" => "Muñoz" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Villafañe" ] 3 => array:4 [ "nombre" => "Carlos Enrique" "apellidos" => "García Franco" "email" => array:1 [ 0 => "c.garciafranco@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cirugia de Tórax, Departamento de Cirugía, Hospital Universitario del Valle, Cali, Colombia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fístula biliotorácica postraumática" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Thoracobiliary fistula is a rare entity that can be caused spontaneously by hepatobiliary infections or, even less frequently, secondary to surgical manipulation or trauma.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 20-year-old patient was admitted to the emergency department with a gunshot wound. The entry wound was in the left paravertebral area of L2, and the exit wound was through the fifth intercostal space on the midline of the right clavicle. Chest radiography showed grade 2 right hemothorax, for which a right pleural drainage catheter was inserted. Subsequently, a thoracoabdominal CT scan revealed findings compatible with grade IV hepatic and renal trauma. There was also evidence of residual pleural effusion after placement of the chest tube. Given the patient’s clinical and analytical stability, we decided to manage the hepatic and renal trauma conservatively. On the third postoperative day, discharge with bile-type characteristics was found in the pleural drainage collection bag. Conservative treatment was maintained for one week, observing progressive clinical and radiological thoracic deterioration. For this reason, we conducted exploratory video-assisted thoracoscopy and found exudate containing blood and bile located in the posterior pleura region, which required pleural decortication. We also found a wound in the right diaphragm measuring approximately 5 cm in length. During recovery, the patient’s progression was slow but adequate from a clinical, analytical and radiological standpoint. The last chest tube was removed when the discharge was less than 50 cc in 24 h, and chest x-ray showed adequate lung re-expansion that correlated with the patient’s clinical improvement. He was discharged on the fourteenth postoperative day.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thoracobiliary fistulae can be classified into 2 groups: biliopleural and biliobronchial. The latter presents higher morbidity and mortality, depending in the complications involved.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the literature, different etiologies have been found for thoracobiliary fistulae: 1) congenital; 2) liver abscesses or hydatid cysts; 3) obstruction of the biliary tract; and 4) liver trauma, which can be a) iatrogenic after surgical or invasive procedures (hepatectomies, radiofrequency, etc.) or b) penetrating trauma.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The latter, thoracoabdominal penetrating trauma, is usually very rare.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It occurs due to a right diaphragmatic injury that creates contiguity between the torn liver and the pleural space. The pathophysiology in this case is as follows: first, we have a liver laceration and diaphragmatic tear secondary to trauma; consequently, we have a biliopleural fistula due to the passage of the bile leaked from the liver laceration, through the torn diaphragm and into the pleural space. In acute situations, early signs and symptoms have been described, such as pain in the right hypochondrium radiating towards the right shoulder, jaundice and, on certain occasions, biliocutaneous fistulae. On chest radiography, it is common to observe an elevated right hemidiaphragm, pulmonary atelectasis and pleural effusion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In reviewing the treatment received by patients with biliopleural fistula, we observed 3 forms of management: surgical, conservative or combined.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Surgical treatment usually involves: pulmonary decortication and suture of the diaphragmatic perforation. Conservative treatment uses the chest tube and bile decompression by means of ERCP. In this case, the patient benefited from combined management—initially conservative with pleural drain placement, and, when this failed, video-assisted thoracoscopic pleural decortication. The tear was not sutured because it was moderate in size and the liver closed the defect from below. Likewise, this defect in the diaphragm allowed the bile to drain through the pleural catheter that otherwise would have leaked into the peritoneal cavity and generated disorders that would be difficult to manage.</p><p id="par0025" class="elsevierStylePara elsevierViewall">If we had opted for closure of the diaphragm defect, we understand that an abdominal drain would have been necessary to evacuate the existing bile leak. This maneuver would have increased the risk of iatrogenesis, while the previous hepatic and abdominal trauma were being resolved conservatively. Said risk of iatrogenesis, in our opinion, would be have been greater than the possible risk of real, but rare, late-onset diaphragmatic hernia in right-side tears covered by the liver.</p><p id="par0030" class="elsevierStylePara elsevierViewall">If conservative management does not prove effective, we stress the importance of trying to manage these patients with minimally invasive surgery. If the decision is delayed too long, this could lead to decortication via thoracotomy once biliothorax has become established.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Semaan L, Muñoz W, Villafañe D, García Franco CE. Fístula biliotorácica postraumática. Cir Esp. 2020;98:366–367.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic thoracobiliary (pleurobiliary and bronchobiliary) fistula" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Andrade-Alegre" 1 => "M. Ruiz-Valdes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0218492312454667" "Revista" => array:7 [ "tituloSerie" => "Asian Cardiovasc Thorac Ann." "fecha" => "2013" "volumen" => "21" "paginaInicial" => "43" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23430419" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028203011452" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biliopleural fistula following gun-shot injury in right axilla" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Dahiya" 1 => "L. Kaman" 2 => "A. Behera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2014-207454" "Revista" => array:5 [ "tituloSerie" => "BMJ Case Rep." "fecha" => "2015" "volumen" => "2015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25948848" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1472648310602568" "estado" => "S300" "issn" => "14726483" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare Canadian case of traumatic biliothorax succesfully managed non-operatively" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Sun" 1 => "G. Pagliarello" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Canadian J Surg." "fecha" => "2016" "volumen" => "59" "numero" => "Suppl 1" "paginaInicial" => "S109" "itemHostRev" => array:3 [ "pii" => "S0015028207012083" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009800000006/v1_202007030632/S217350772030106X/v1_202007030632/en/main.assets" "Apartado" => array:4 [ "identificador" => "15076" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009800000006/v1_202007030632/S217350772030106X/v1_202007030632/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217350772030106X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 6 | 1 | 7 |
| 2024 September | 22 | 5 | 27 |
| 2024 August | 14 | 4 | 18 |
| 2024 July | 9 | 6 | 15 |
| 2024 June | 8 | 4 | 12 |
| 2024 May | 8 | 3 | 11 |
| 2024 April | 9 | 4 | 13 |
| 2024 March | 36 | 3 | 39 |
| 2024 February | 16 | 2 | 18 |
| 2024 January | 10 | 2 | 12 |
| 2023 December | 21 | 10 | 31 |
| 2023 November | 16 | 4 | 20 |
| 2023 October | 16 | 7 | 23 |
| 2023 September | 11 | 5 | 16 |
| 2023 August | 15 | 11 | 26 |
| 2023 July | 13 | 6 | 19 |
| 2023 June | 19 | 17 | 36 |
| 2023 May | 41 | 14 | 55 |
| 2023 April | 45 | 3 | 48 |
| 2023 March | 26 | 5 | 31 |
| 2023 February | 22 | 11 | 33 |
| 2023 January | 14 | 14 | 28 |
| 2022 December | 11 | 6 | 17 |
| 2022 November | 17 | 7 | 24 |
| 2022 October | 19 | 15 | 34 |
| 2022 September | 15 | 9 | 24 |
| 2022 August | 56 | 11 | 67 |
| 2022 July | 46 | 9 | 55 |
| 2022 June | 12 | 8 | 20 |
| 2022 May | 28 | 9 | 37 |
| 2022 April | 19 | 13 | 32 |
| 2022 March | 24 | 10 | 34 |
| 2022 February | 15 | 6 | 21 |
| 2022 January | 15 | 5 | 20 |
| 2021 December | 16 | 13 | 29 |
| 2021 November | 13 | 12 | 25 |
| 2021 October | 19 | 9 | 28 |
| 2021 September | 14 | 12 | 26 |
| 2021 August | 21 | 5 | 26 |
| 2021 July | 15 | 16 | 31 |
| 2021 June | 22 | 8 | 30 |
| 2021 March | 0 | 1 | 1 |
| 2021 January | 0 | 3 | 3 |
| 2020 December | 0 | 3 | 3 |
| 2020 November | 0 | 1 | 1 |
| 2020 October | 2 | 3 | 5 |
| 2020 September | 5 | 1 | 6 |
Show all
