Case reportTraumatic thoracobiliary fistulae: a case report with a review of the current management options
Section snippets
Case report 1
A 38-year-old man presented with a thoraco-abdominal gunshot wound involving the right chest and abdomen. On examination, he had a systolic blood pressure of 100 mmHg, a pulse rate of 110 beats/min, and a finger prick haemoglobin of 9 g%. Clinically he had an acute abdomen. Urine microscopy was normal and a chest X-ray (CXR) showed a right-sided effusion. A traumatic haemothorax was drained from the right chest cavity with a tube thoracostomy. At laparotomy, 1100 ml of free intraperitoneal blood
Discussion
Thoracobiliary fistulae (pleurobiliary and bronchobiliary) are extremely rare complications following penetrating thoraco-abdominal trauma. They are typically associated with obstructive biliary and infective (amoebic, pyogenic, tuberculosis, echinococcosis) liver disease. In a single series of 3608 non-traumatic, subphrenic abscesses, the incidence of bronchobiliary fistulae was 10% [1]. Biliary fistulae occur in 2–4% of all cases of hepatic trauma, irrespective of the mechanism of injury [2],
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