BILOTHORAX: A RARE COMPLICATION OF CHOLECYSTECTOMY

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bilothorax is a rare cause exudative pleural effusions that was first reported in 1971.(1) There have been less than 70 cases since then.(2) Most are right sided and arise as complication hepatobiliary surgery. Here we report case an elderly male who developed biliopleural fistula with recurrent bilothorax laparoscopic cholecystectomy. CASE PRESENTATION: A 69-year-old history hypertension, diabetes, hyperlipidemia presented to hospital symptoms acute cholecystitis. He underwent cholecystectomy complicated post-operatively by hepatic subcapsular hematoma. subsequent artery embolization attempt periprocedural cardiac arrest successful resuscitation. thereafter liver failure transferred transplant center for management. Liver function improved supportive care however he new-onset exertional dyspnea setting new right-sided effusion. thoracentesis performed, fluid studies revealed effusion elevated total bilirubin level (6.4 mg/dl), greater serum (4.8 consistent bilothorax. CT-scan abdomen collection gallbladder fossa concerning biloma. MRCP then performed showed multiple collections communicating peripheral bile duct, suggestive biliary leakage. This followed ERCP sphincterotomy stent placement across ampulla allow optimal drainage. The patient continued requiring thoracenteses relief. chest tube placed but removed after 8 days due persistent daily Slower re-accumulation observed thereafter. discharged rehabilitation facility plans serial imaging thoracostomy needed. repeat planned 2 months removal stent. DISCUSSION: high index suspicion should be present patients developing procedure. diagnosis established when ratio 1.0.(2) In our 1.33. Empyema formation common these therefore immediate drainage warranted, early antibiotic administration considered. Treatment remains challenge, conservative non-surgical management endoscopic decompression has some cases.(3) CONCLUSIONS: Biliopleural causing procedures warrants action. Conservative ensuring adequate may appropriate patients. REFERENCE #1: Williams SW, Majewski PL, Norris JE, Cole BC, Doohen DJ. Biliary treatment Am J Surg. 1971;122(6):829-831. #2: Austin, A., Fox, N., Huggins, J., & Chopra, A. (2017). green effusion: comprehensive review series. PLEURA. 2017;4:21-31. #3: Cooper AZ, Gupta A, Odom SR. resulting from blunt trauma. Ann Thorac 2012;93(6):2043-2044. DISCLOSURES: No relevant relationships Fatima Hayat, source=Web Response Emil Oweis,