A Case of Empyema Caused by Biliopleural Fistula Improved Using Thoracoscopy Under Local Anesthesia

DOI
  • Inada Shugo
    Department of Respiratory Internal Medicine, Hiroshima University Hospital Department of Respiratory Internal Medicine, Kitakyushu General Hospital
  • Morimoto Toshiki
    Department of Respiratory Internal Medicine, Kitakyushu General Hospital
  • Iwanaga Yuto
    Department of Respiratory Internal Medicine, Kitakyushu General Hospital
  • Nabeshima Shinji
    Department of Respiratory Internal Medicine, Kitakyushu General Hospital
  • Orihashi Takeshi
    Department of Respiratory Internal Medicine, Kitakyushu General Hospital
  • Nakashima Taku
    Department of Respiratory Internal Medicine, Hiroshima University Hospital
  • Iwamoto Hiroshi
    Department of Respiratory Internal Medicine, Hiroshima University Hospital
  • Fujitaka Kazunori
    Department of Respiratory Internal Medicine, Hiroshima University Hospital
  • Hamada Hironobu
    Department of Respiratory Internal Medicine, Hiroshima University Hospital
  • Hattori Noboru
    Department of Respiratory Internal Medicine, Hiroshima University Hospital

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  • 胆管胸腔瘻による膿胸に対して局所麻酔下胸腔鏡が有用であった1例

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Abstract

<p>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.</p>

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