Abstract
Background. Biliopleural fistula is a rare complication of percutaneous transhepatic biliary drainage (PTBD). Although thoracic drainage, surgical curettage, and fistula closure have been reported as treatments, to our knowledge, there have been very few reports on thoracoscopy under local anesthesia. Case. An 89-year-old man had undergone biliary stent replacement for obstructive jaundice due to a duodenal papilla tumor and was hospitalized for acute cholecystitis and cholangitis by biliary stent obstruction. Three days after PTBD, he developed a fever, and chest X-ray revealed extensive right pleural effusion. Chest computed tomography confirmed that the PTBD catheter had penetrated the chest cavity. Experimental pleurocentesis revealed bile-like pleural effusion, and Enterococcus faecium and Pseudomonas aeruginosa were detected in a culture test. Empyema due to a bilopleural fistula was diagnosed. The right chest cavity formed by the intrathoracic fibrin was curetted by thoracoscopy (LTF-240) under local anesthesia, and two chest drains were inserted. The empyema and cholangitis showed improving trends following thoracic draining and treatment with antibiotics. Later, the PTBD catheter was removed, and right diaphragm fistula closure was performed using thoracoscopy under local anesthesia. Conclusion. Thoracoscopy under local anesthesia can be useful for managing empyema due to biliary thoracic fistulas. It may be particularly useful for patients with a poor performance status due to age or carcinoma who are unable to undergo highly invasive surgical procedures under general anesthesia.
