{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:18:42Z","timestamp":1768004322449,"version":"3.49.0"},"reference-count":28,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T00:00:00Z","timestamp":1700092800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>Biliopleural fistula is a rare but serious complication after liver transplantation that should be managed nonoperatively with antibiotics, pleural drainage, decompression of high\u2010pressure biliary tract, or ultimately surgery in unresponsive cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>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\u2010year\u2010old 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\u2010Pratt 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\u2010spectrum intravenous antibiotic therapy was started, followed by cholangiography, fistula closure, and bile duct stricture ballooning and internal\u2010external 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.8210","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T08:40:47Z","timestamp":1700210447000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Nonoperative management of biliopleural fistula following living\u2010donor liver transplantation: A case report"],"prefix":"10.1002","volume":"11","author":[{"given":"Kourosh","family":"Kazemi","sequence":"first","affiliation":[{"name":"Shiraz Transplant Center Abu Ali Sina Hospital, Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alireza","family":"Rasekhi","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center Abu Ali Sina Hospital, Shiraz University of Medical Sciences  Shiraz Iran"},{"name":"School of Medicine Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar Sohrabi","family":"Nazari","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center Abu Ali Sina Hospital, Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Mehdi","family":"Lashkarizadeh","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center Abu Ali Sina Hospital, Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alireza","family":"Shamsaeefar","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center Abu Ali Sina Hospital, Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Alikhani","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center Abu Ali Sina Hospital, Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Akbari","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center Abu Ali Sina Hospital, Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5454-495X","authenticated-orcid":false,"given":"Reza","family":"Shahriarirad","sequence":"additional","affiliation":[{"name":"School of Medicine Shiraz University of Medical Sciences  Shiraz Iran"},{"name":"Thoracic and Vascular Surgery Research Center Shiraz University of Medical Science  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,16]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(02)03382-9"},{"key":"e_1_2_12_3_1","article-title":"Gossypiboma causing mechanical intestinal obstruction: a case report","volume":"2012","author":"Aydogan A","year":"2012","journal-title":"Case Rep Surg."},{"issue":"1","key":"e_1_2_12_4_1","first-page":"28","article-title":"Pleuro\u2010biliary fistula\u2014a delayed complication following open cholecystectomy","volume":"24","author":"Prabhu R","year":"2005","journal-title":"Indian J Gastroenterol"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588413X13629960047678"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1308\/147870810X12699662980637"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.11.024"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-207454"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2022.107126"},{"issue":"1","key":"e_1_2_12_10_1","first-page":"E12","article-title":"Importance of liver drainage in biliary\u2010bronchopleural fistula resulting from thoracoabdominal gunshot injury","volume":"52","author":"Ball CG","year":"2009","journal-title":"Can J Surg"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/137.4.959"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.21037\/qims-21-447"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v13.i23.3268"},{"issue":"11","key":"e_1_2_12_14_1","first-page":"1189","article-title":"Biliopleural fistula with cholethorax. 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