PURPOSE: Traumatic thoracobiliary fistulas are rare but serious complications. A series of thoracobiliary fistulas secondary to penetrating trauma and analysis of trends in management are presented.
METHODS: A retrospective review was made of all patients with traumatic thoracobiliary fistulas who were treated from 2008 to 2009. There were five patients of whom four suffered gunshot wounds and one stabbed. The information from the charts included: sex, age, injury severity scores, grades of hepatic injury, initial surgical procedures, diagnostic methods, definitive treatment procedures, complications and follow up.
RESULTS: Injury severity scores averaged 22 (range 13-38). Grade of hepatic injury was IV in two patients and III, II and I in one patient each. Initial treatment included chest tubes for all; one patient underwent damage control surgery and hepatic packing; three patients were managed with laparotomy and peri-hepatic closed suction drainage. Two patients developed bronchobiliary fistulas and three pleurobiliary fistulas. Diagnostic methods included determination of bilirrubin in pleural fluid, computed tomography, magnetic resonance cholangiography, HIDA, endoscopic retrograde cholangiography and percutaneus transhepatic cholangiography. Definitive treatment consisted of endoscopic retrograde cholangiography with stent/sphincterotomy in 3 cases, video thoracoscopy in 2 and thoracotomy in 4. The latter included procedures such as fistulectomy 2, decortication 4, hepatic suture 2, closed suction drainage 4, suture of diaphragm 4. The post-operative length of stay averaged 18 days (range 7 to 48 days). There was no morbidity associated with the definitve procedure and there was no mortality.
CONCLUSION: Traumatic thoracobiliary fistulas are complex lesions. Treatments have varied throughout the past decades due to constant developments of new diagnostic tools and treatment procedures. A multidisciplinary approach is required for a timely and successful outcome.
CLINICAL IMPLICATIONS: Suspicion of thoracobiliary fistula warrants a multidisciplinary approach for expeditious diagnosis and treatment.
DISCLOSURE: Rafael Andrade-Alegre, No Financial Disclosure Information; No Product/Research Disclosure Information