Conservative management of thoracobiliary fistula.
BACKGROUND
Thoracobiliary fistulas are rare manifestations of biliary disruption. Given their rarity it is not surprising that there is little consensus on the optimal management of thoracobiliary fistulas.


METHODS
Patients presenting with thoracobiliary fistulas over a 5-year period (1996 to 2001) were evaluated. Initial management was conservative with tube thoracostomy or drainage of sepsis when appropriate, or both; antibiotics and somatostatin were routinely administered. Endoscopic retrograde cholangiography was performed when symptoms persisted to delineate the thoracobiliary communication and undertake sphincteroplasty.


RESULTS
Eight patients with a mean age of 31.9 years (range 15 to 42) were evaluated. Biliary effusion occurred in 3 patients after hepatic injury (n = 2) and percutaneous transhepatic cholangiography (n = 1). Bilioptysis occurred in 5 patients after hepatic abscess (n = 4) and hepatic injury (n = 1) The biliary effusion (n = 3) was successfully managed by endoscopic sphincterotomy in 2 patients; the third patient underwent urgent surgical biliary drainage. Bilioptysis (n = 5) was successfully managed in 3 patients; persistence of symptoms in 2 patients prompted surgical intervention.


CONCLUSIONS
Thoracobiliary fistulas may be successfully managed using a conservative approach. Surgery should be reserved for persistence of symptoms after exhaustion of this approach.
Singh
Bhugwan
B
Department of General Surgery, Faculty of Health Sciences, Nelson R. Mandela School of Medicine, University of Natal, Congella, South Africa. moodleyj6@nu.ac.za
Moodley
Jaynathan
J
Sheik-Gafoor
Mohamed H
MH
Dhooma
Naseem
N
Reddi
Anunathan
A
D000293:Adolescent; D000328:Adult; D001658:Biliary Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002758:Cholangiography / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries; D008101:Liver Abscess, Amebic / Q000150:complications; D008297:Male; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic