Traumatic biliopleural fistula. Presentation of two cases

Abstract

Biliopleural fistula is a rare condition. It represents a low percentage of the complications of penetrating trauma with associated liver injury. Reports of this condition have largely been in the form of “case reports”. Therefore, it is not surprising that clear guidelines for the optimal management of biliopleural fistula are lacking. The cardinal sign consists of post-traumatic pleural effusion containing bile fluid. Computed tomography and ultrasound are the methods of choice to rule out associated complications and serve as a guide for percutaneous drainage if necessary. Both methods are not useful to delimit the exact anatomical location of the fistula, which is necessary to determine the therapeutic approach to follow. The method of choice for assessing the biliary tree is endoscopic retrograde cholangiopancreatography. Treatment of biliopleural fistula involves aggressive surgical management, with exploratory laparotomy, bile duct bypass or drainage, abdominal cavity lavage and thoracotomy with diaphragm repair. However, with the advent of endoscopy, interventional radiology and minimally invasive techniques, treatment has changed and has become a challenge for the trauma surgeon. Two cases are presented with the aim of analyzing the treatment of biliopleural fistulas resulting from open thoracic-abdominal trauma. The results are compared with the literature and a treatment algorithm is proposed for possible subsequent cases.