title: Traumatic thoracobiliary (pleurobiliary and bronchobiliary) fistula.
abstract: BACKGROUND
  Traumatic thoracobiliary fistula is a rare but serious complication. A series of thoracobiliary fistulas secondary to penetrating trauma and analysis of trends in management are presented.
  
  
  METHODS
  We retrospectively reviewed all patients with traumatic thoracobiliary fistula, treated from April 2008 to February 2010. There were 5 patients: 4 suffered gunshot wounds and 1 was stabbed. The mean injury severity score was 22.
  
  
  RESULTS
  Initial treatment was insertion of a chest tube in all cases. One patient underwent damage-control surgery and hepatic packing, and 3 were managed with laparotomy, a perihepatic closed drain, and suture of the diaphragm. Two patients developed bronchobiliary fistulas and 3 had pleurobiliary fistulas. Diagnostic procedures involved determination of bilirubin in pleural effusion, computed tomography, magnetic resonance cholangiography, hepatobiliary iminodiacetic scans, and endoscopic retrograde cholangiography. Definitive treatment included sphincterotomy and stenting in 4 cases, pulmonary decortication in 5, fistulectomy in 2, hepatic suture in 2, perihepatic closed drain placement in 4, and suture of the diaphragm in 4.
  
  
  CONCLUSIONS
  Traumatic thoracobiliary fistulas are complex lesions. A multidisciplinary approach is required for a timely and successful outcome. Endoscopic retrograde cholangiography is very useful as the initial procedure to confirm the diagnosis and also for treatment.
authors: Thoracic Surgery Section, Santo Tomás Hospital, Panamá, Republic of Panama. toravasc@cwpanama.net
authors: Rafael
authors: R
authors: Andrade-Alegre
authors: Maylin
authors: M
authors: Ruiz-Valdes
mesh_terms: D000293:Adolescent; D000328:Adult; D001658:Biliary Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001663:Bilirubin / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015505:Chest Tubes; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D006801:Humans; D007098:Imino Acids; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011237:Predictive Value of Tests; D013510:Pulmonary Surgical Procedures; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications*; D014951:Wounds, Stab / Q000150:complications*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007098:Imino Acids; D019275:Radiopharmaceuticals; D001663:Bilirubin; C008109:iminodiacetic acid