Left hepatic duct injury and thoracobiliary fistula after abdominal blunt trauma

Abstract

Thoracobiliary fistula after blunt hepatic trauma is rare. We report a case of pleurobiliary fistula after a blunt hepatic trauma leading to a left hepatic lobe laceration together with a left hepatic duct injury. The management of this traumatic lesion is discussed and related to the existing literature data. The diagnosis of traumatic thoracobiliary fistula rests upon clinical suspicion in the setting of a persistent right pleural effusion. Demonstration of the presence of bile in the pleural cavity by thoracocentesis is considered a proof of pleural biliary fistula. We think that laparotomy is an appropriate route for the treatment of pleurobiliary fistulas. However, when a bronchobiliary fistula is suspected, the patient should be treated with thoracotomy and may require pulmonary resection to remove the fistulous tracts.