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• W4387251930 abstract "SESSION TITLE: Disorders of Pleura Case Report Posters 8 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: This is a case of a 76-year-old man with recent pancreaticoduodenectomy complicated by abscess and bacteremia who initially presented with new biliary obstruction and hepatic abscess requiring biliary drain placement. Due to continued bilious drainage, he was referred to our institution for drain internalization but was found to have a trans-pleural drain requiring replacement. His hospital course was complicated by accumulation of a bilothorax and empyema. CASE PRESENTATION: This was a 76-year-old man with recent pancreaticoduodenectomy for pancreatic adenocarcinoma complicated by Enterobacter-associated intra-abdominal abscess and Klebsiella bacteremia, who initially presented with biliary obstruction and a hepatic abscess. He received external biliary drains and antibiotics because he did not have anatomy amenable to endoscopic management. He was referred to our facility for biliary drain internalization and was found to have a drain traversing the pleura, which was replaced. Soon thereafter, he developed a right-sided pleural effusion with lower lobe lung collapse (Figure 1); a thoracic pigtail catheter was placed which revealed bilious drainage. Intraoperative cholangiography revealed a small pleural leak requiring biliary drain upsizing. Pleural fluid analysis revealed an exudative effusion with Enterococcus growth. Thoracic surgery evaluated the patient, initially deferring surgery and recommending antibiotics. However, given a decline in the patient's respiratory status and thoracic output as well as repeat imaging showing a non-resolving effusion (Figure 2), thoracic surgery completed a video-assisted thoracoscopic surgery with decortication and replacement of the pigtail catheter with a chest tube. The patient did well post-operatively, with radiographic and clinical improvement (Figure 3); he was discharged home after chest tube removal, with a plan for outpatient antibiotics and chemotherapy. DISCUSSION: Bilious pleural effusion, or bilothorax, is a rare but known cause of pleural effusion from pleurobilial fistula formation due to biliary tract injury or manipulation or from subphrenic abscess formation. This patient likely developed a bilothorax in the setting of initial trans-pleural placement of a biliary drain, leading to a communication between the pleural space and peritoneum when removed. Patients with bilothorax are at increased risk of empyema and require immediate management with intravenous antibiotics and drainage of the pleural space to prevent infection. Surgical management can be required, especially if there is minimal improvement after biliary drain placement and antibiotics, and it should not be delayed given a high risk of decompensation as highlighted by this case. CONCLUSIONS: This case highlights bilothorax, a condition that requires prompt evaluation and treatment. Surgical intervention should be considered early due to considerable risk of decompensation. REFERENCE #1: Austin, A., Fox, N., Huggins, J., & Chopra, A. (2017). The Green Pleural Effusion: A Comprehensive Review of the Bilothorax with Case Series. Pleura, 4, 21–31. REFERENCE #2: Sahn S. A. (2006). Pleural effusions of extravascular origin. Clinics in chest medicine, 27(2), 285–308. https://doi.org/10.1016/j.ccm.2005.12.004 REFERENCE #3: Addas, R. A., Alsabban, A. M., Fallatah, A. A., Binaqeel, A. S., Bafageeh, S. W., Bawazir, A. O., Addas, R. A., Alsabban, A. M., Fallatah, A. A., Binaqeel, A. S., Bafageeh, S. W., & Bawazir, A. O. (2021). Bilothorax a Rare Incidence in Thoracic Surgery: Case Report and Literature Review. Open Journal of Thoracic Surgery, 11(03), 76–82. https://doi.org/10.4236/ojts.2021.113010 DISCLOSURES: No relevant relationships by George Boghdadi No relevant relationships by Kellen Mulhern No relevant relationships by Purven Parikh" @default.
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• W4387251930 date "2023-10-01" @default.
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• W4387251930 title "REVISITING BILOTHORAX: A RARE COMPLICATION OF BILIARY TRACT MANIPULATION" @default.
• W4387251930 doi "https://doi.org/10.1016/j.chest.2023.07.2377" @default.
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