Traumatic thoracobiliary (pleurobiliary and bronchobiliary) fistulas: clinical and review study

Thoracobiliary fistulas are rare complications of thoracoabdominal trauma, with high morbidity and potentially high mortality. Our experience with four cases and 12 other cases collected from the literature are reviewed. All patients were male and average age was 25 years. Five had blunt trauma, three had stab wounds, and eight, gunshot wounds. All had diaphragmatic and hepatic injuries. Bronchobiliary fistulas with biliptysis developed in seven patients. Fever, cough, chest and RUQ pains were the most common presenting symptoms. Pleural effusion and elevated right hemidiaphragm were the most common X-ray findings. Bile empyema developed in 2/3 of the patients. Early diagnosis, tube thoracostomy with adequate drainage of all subphrenic billious collections, and secure closure of all diaphragmatic perforations are essential in successful management of most of these fistulas. Thoracotomy, however, is indicated in chronic and complicated fistulas, and should not be delayed beyond 3 weeks. Judicious use of appropriate antibiotics is a necessary adjunct to adequate surgical management of these fistulas. All 16 patients survived.