Nonoperative management of biliopleural fistula following living ‐donor liver transplantation: A case report

Image of the percutaneous transhepatic cholangiography demonstrating dilated intrahepatic bile ducts with stricture at the site of hepaticojejunostomy anastomosis and leakage from cut surface resulting in biliopleural fistula (white arrow). Bilio-enteric continuity was seen with free passage of injected dye to the jejunal limb during cholangiography (black arrow). Key Clinical MessageBiliopleural fistula is a rare but serious complication after liver transplantation that should be managed nonoperatively with antibiotics, pleural drainage, decompression of high-pressure biliary tract, or ultimately surgery in unresponsive cases.AbstractBilious pleural effusion is a rare entity often iatrogenic, following hepatobiliary surgeries and biliary interventions, and has been reported only in a limited number of patients after liver transplantation. A 5-year-old girl underwent living donor liver transplantation due to progressive familial intrahepatic cholestasis. At the 7th day of the postoperative course, due to increased liver enzymes and bilirubin levels and intrahepatic bile duct dilatation on sonography, Magnetic Resonance Cholangiopancreaticography followed by a liver biopsy were performed; the findings demonstrated moderate intrahepatic bile duct dilatation and moderate cellular rejection associated with mild cholestasis, respectively. The patient was therefore administered a pulse of methylprednisolone; however, due to fever, peritonitis and also sonographic evidence of infect...
Source: Clinical Case Reports - Category: General Medicine Authors: Tags: CASE REPORT Source Type: research