N. Y. Kim1, M. G. Sadowsky2, K. C. Woodyard1, C. Williams2, C. F. Janowak2 1University Of Cincinnati, College Of Medicine, Cincinnati, OH, USA 2University Of Cincinnati, College Of Medicine, Department Of Surgery, Cincinnati, OH, USA
Introduction: Thoracobiliary fistula (TBF) is a rare and highly morbid complication of hepatic trauma. There is a paucity of literature regarding incidence, disease course, and treatment. This study identifies etiologic factors and outcomes patterns in patients at risk for TBF.
Methods: A retrospective review was performed of patients presenting with concomitant right diaphragm and liver injury over an 8-year period (2014 to 2021) at an urban level 1 trauma center. Early post-injury deaths were excluded. Characteristics of patients with and without TBF were compared using Fisher’s exact and Mann-Whitney U tests. The disease courses of patients with TBF were further examined.
Results: 118 patients with concomitant right diaphragm and liver injury were reviewed, with 114 patients (96.6%) surviving longer than 72 hours. Four patients developed TBF (3.5%). Patients with TBF were younger (p=0.01) and had trends towards less frequent liver repair (p=0.061) or concomitant liver and diaphragm repair (p=0.066). Performance of Video-Assisted Thoracoscopic Surgery (VATS) for retained hemothorax was associated with increased risk of TBF (p=0.005). Patients with TBF were significantly more likely to develop infectious complications such as sepsis, pneumonia or complicated parapneumonic effusion (p<0.001). Those who developed TBF were treated with ERCP, sphincterotomy, and stent placement.
Conclusion: Although TBF incidence is low, patients with concomitant right hemidiaphragm and liver trauma may be at higher risk for developing TBF if not repaired surgically. This injury is characterized by infectious complications requiring further interventional treatment and monitoring.
