Abstract: Bilious
pleural effusion is a rare entity often iatrogenic, following hepatobiliary surgeries and biliary interventions, and has been reported only in a limited number of patients after
liver transplantation. A 5-year-old girl underwent living donor
liver transplantation due to
progressive familial intrahepatic cholestasis. At the 7th day of the postoperative course, due to increased liver
enzymes and
bilirubin levels and intrahepatic bile duct dilatation on sonography, Magnetic Resonance Cholangiopancreaticography followed by a liver biopsy were performed; the findings demonstrated moderate intrahepatic bile duct dilatation and moderate cellular rejection associated with mild
cholestasis, respectively. The patient was therefore administered a pulse of
methylprednisolone; however, due to
fever,
peritonitis and also sonographic evidence of infected biloma collection adjacent to the transplanted liver, the patient underwent surgery.
Laparotomy and peritoneal washout were performed and a Jackson-Pratt drain was inserted adjacent to the liver cut surface. Succeeding
tachypnea on 28th post day, led to detection of right side massive
pleural effusion on chest Xray and hence
thoracostomy tube was inserted. A diagnosis of biliopleural
fistula was established and broad-spectrum intravenous
antibiotic therapy was started, followed by cholangiography,
fistula closure, and bile duct
stricture ballooning and internal-external biliary
catheter insertion. The patient was discharged in generally good condition on the 50th posttransplant day. The diagnosis of biliopleural
fistula is facilitated with the utilization of chest imaging and pleural fluid analysis, however, a high index of suspicion is required.