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Ann Thorac Surg 2004;78:339-341
© 2004 The Society of Thoracic Surgeons

Case report

Spontaneous biliopneumothorax (thoracobilia) following gastropleural fistula due to stomach perforation by nasogastric tube

Alessandro Bini, MDa, Manuele Grazia, MDa, Francesco Petrella, MD*a, Franco Stella, MDa, Ruggero Bazzocchi, MDa

a Department of General and Thoracic Surgery, "S. Orsola— Malpighi" Hospital, University of Bologna, Bologna, Italy

Accepted for publication June 13, 2003.

* Address reprint requests to Dr Petrella, Department of General and Thoracic Surgery, "S. Orsola—Malpighi" Hospital, University of Bologna, Via Massarenti 9, Bologna, Italy, Bologna, Bologna, Italy Italy
e-mail: fpetrella{at}libero.it

Gastropleural fistula may occur after pulmonary resection, perforated paraesophageal hernia, perforated malignant gastric ulcer at the fundus, or gastric bypass surgery for morbid obesity. We describe a case of gastropleural fistula after stomach perforation by a nasogastric tube in a patient who underwent Billroth II gastric resection for adenocarcinoma. Left biliopneumothorax occurred and was treated by thoracic drainage with –20 cm H2O aspiration. As gastropleural fistula persisted, laparotomy was repeated and gastric and diaphragmatic perforations were sutured. Gastropleural fistula is rare and, to our knowledge, this is the first reported case of gastropleural fistula and biliopneumothorax caused by gastric and diaphragmatic perforation by a nasogastric tube.






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