INTRODUCTION: Bilothorax is a rare complication occuring after trauma, invasive procedures applied to abdomen. This case report of bilothorax was occured after an operation of pyloric stenosis since there were no fistula or rupture of diaphragm.
CASE PRESENTATION: 35-year-old man was admitted to the hospital with the complaints of nausea, vomiting, weightloss. He had a diagnosis pyloric stenosis in his gastrointestinal endoscopy. He had underwent on surgical intervention under general anaesthesia and a hemigastrectomy with gastrojejunostomy was performed. The complaints of dyspnoea and left chest pain were appeared on the postoperative 4th day. Physical examination revealed the loss of breath sounds at the lower field of left hemithorax. Chest roentgenogram showed a pleurisy at the left lower zone and thoracentesis revealed bilothorax (Table 1-Figure 1). On his computerized tomography, a left sided pleural effusion and the atelectasis of left lobar segments with calsification were detected. Abdominal exploration revealed there was no diaphragmatic defect or fistula, the same effusion in the abdominal space and a leakage from duedonal stump were detected. It had been drained about 2000 ml of effusion, the leakage from the duedonal stump was primarily repaired. Thereafter abdominal drain were inserted. After this procedure therapeutic thoracentesis applied if it was necessary. Postoperative 25th days, there was no fistula or defect on the diaphragmatic surface through fistulography. The chest X ray showed a minimal density on the left lower zone on the 32 th day.
DISCUSSIONS: In the English literature, the bilothorax was resulted usually from a fistula due to a trauma or related with a surgical intervention, diaphragmatic defect, another disease of the bile duct. Also it could be occured by the transmission of abdominal effusion from the diaphragmatic pores to the thorax. We are thinking that the reason of the bilothorax in our patient could be the latter. A significant contributing factor may be that he had a previous pyloric stenosis and gastric surgery, and they had been a faciliating effect of the passage of the bile. He had a left sided pleural effusion, and there was a few case reports of the left bilothorax in the literature related with thoracobilier fistula after trauma or invasive procedures. In the case report of Rowes, there was a perforation of the afferent loop of an old gastrojejunostomy (1 ).
CONCLUSION: In summary, the bilothorax is not a common complication of upper abdominal surgery. In this case, we should be carefully evaluated the reason, since it may be an important complication of the surgical procedure.
DISCLOSURE: Canan Hasanoglu, None.