Anke Waelbers1, Elisabeth L I M Duval, D Vervloessem. 1. Paediatric Intensive Care Unit, and the Department of Paediatric Surgery, Queen Paola Children's Hospital, Lindendreef 11, Antwerp, Belgium.
Abstract
OBJECTIVE: Thoracobiliary fistula, subsequent to a combined thoracic and hepatic blunt trauma, is a rare complication, which calls for a high index of suspicion during diagnostic workup. Due to its uncommon nature, especially in children, and hence the paucity of reports in literature, no consensus has been reached on its optimal management. PATIENTS AND METHODS: We report on a 4-yr-old girl, who developed a cholothorax after a blunt thoracoabdominal trauma. She was successfully treated through conservative management with drainage, antibiotics, and a low-fat diet. The cases previously described in the English literature are reviewed, and management is discussed. CONCLUSION: The recent tendency to observe rather than explore abdominal trauma and the absence of a definitive diagnostic test for diaphragmatic injury may contribute to a delayed diagnosis of the components that may result in the development of a fistula. Literature review substantiates endoscopic retrograde cholangiopancreatography as the imaging modality of choice, because it has the potential of therapeutic intervention by sphincterotomy or stent placement. A nonoperative approach was successful in this case.
OBJECTIVE: Thoracobiliary fistula, subsequent to a combined thoracic and hepatic blunt trauma, is a rare complication, which calls for a high index of suspicion during diagnostic workup. Due to its uncommon nature, especially in children, and hence the paucity of reports in literature, no consensus has been reached on its optimal management. PATIENTS AND METHODS: We report on a 4-yr-old girl, who developed a cholothorax after a blunt thoracoabdominal trauma. She was successfully treated through conservative management with drainage, antibiotics, and a low-fat diet. The cases previously described in the English literature are reviewed, and management is discussed. CONCLUSION: The recent tendency to observe rather than explore abdominal trauma and the absence of a definitive diagnostic test for diaphragmatic injury may contribute to a delayed diagnosis of the components that may result in the development of a fistula. Literature review substantiates endoscopic retrograde cholangiopancreatography as the imaging modality of choice, because it has the potential of therapeutic intervention by sphincterotomy or stent placement. A nonoperative approach was successful in this case.