title: Spontaneous biliopneumothorax (thoracobilia) following gastropleural fistula due to stomach perforation by nasogastric tube.
abstract: Gastropleural fistula may occur after pulmonary resection, perforated paraesophageal hernia, perforated malignant gastric ulcer at the fundus, or gastric bypass surgery for morbid obesity. We describe a case of gastropleural fistula after stomach perforation by a nasogastric tube in a patient who underwent Billroth II gastric resection for adenocarcinoma. Left biliopneumothorax occurred and was treated by thoracic drainage with -20 cm H2O aspiration. As gastropleural fistula persisted, laparotomy was repeated and gastric and diaphragmatic perforations were sutured. Gastropleural fistula is rare and, to our knowledge, this is the first reported case of gastropleural fistula and biliopneumothorax caused by gastric and diaphragmatic perforation by a nasogastric tube.
authors.affiliation: Department of General and Thoracic Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bini
authors.forename: Manuele
authors.initials: M
authors.lastname: Grazia
authors.forename: Francesco
authors.initials: F
authors.lastname: Petrella
authors.forename: Franco
authors.initials: F
authors.lastname: Stella
authors.forename: Ruggero
authors.initials: R
authors.lastname: Bazzocchi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D001646:Bile; D003964:Diaphragm / Q000293:injuries* / Q000601:surgery; D004322:Drainage; D005747:Gastric Fistula / Q000150:complications*; D005763:Gastroenterostomy; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000382:microbiology; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D007813:Laparotomy; D008207:Lymphatic Metastasis; D008297:Male; D010995:Pleural Diseases / Q000150:complications*; D011030:Pneumothorax / Q000209:etiology* / Q000382:microbiology; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D016156:Respiratory Tract Fistula / Q000150:complications*; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification; D013270:Stomach / Q000293:injuries* / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery; D013276:Stomach Ulcer / Q000209:etiology; D013907:Thoracostomy