Bilothorax as a complication of endoscopic retrograde cholangiopancreatography: A rare case report and literature review

Bilothorax is a rare and poorly documented condition in the medical literature, with following hepatobiliary procedures being the most common cause. We present a case of bilothorax following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. A 71-year-old woman with a history of prior percutaneous biliary stone removals presented with Charcot's triad and was diagnosed with cholangitis due to a distal common bile duct stone. She underwent ERCP with successful stone extraction and stent placement. Two days later, she developed a right-sided pleural effusion diagnosed as a post-ERCP bilothorax. She was treated with thoracentesis and antibiotics, and her condition significantly improved. After 15 days, she was discharged, and a one-month follow-up showed no complications or recurrence. Bile is a potent chemo irritant that can cause adhesive pleurodesis. Besides, accompanying cholangitis can lead to pleural infection and empyema. In this patient, early diagnosis leading to timely pleural drainage decisions helped avoid potential consequences. Post-ERCP bilothorax is a rare complication but can lead to severe consequences. Nonoperative management by pleural drainage is a safe and effective strategy if diagnosis is made early, helping patients avoid more invasive interventions. •Post-ERCP bilothorax is a rare complication.•A high degree of clinical suspicion is needed to prevent complications, especially empyema.•Nonoperative management by thoracentesis is a safe and effective strategy.