Bilothorax following peritoneal cytoreductive surgery for recurrent ovarian cancer

Bilothorax is a rare and under-recognized complication of hepatobiliary interventions, especially cytoreductive surgeries and is associated with increased length of hospitalization, morbidity and mortality. There are ˂100 reported cases in the literature, and due to its rarity, no standardized diagnostic tests or treatment guidelines are currently available. We present a 58-year-old otherwise healthy woman with a history of recurrent ovarian cancer who underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy with curative intent. Her postoperative course was complicated by delayed abdominal bile leak, followed by progressive respiratory decline which failed initial conservative treatments. She underwent drainage and frank bile was obtained. The patient ultimately responded to broad-spectrum antibiotics and the placement of dual intercostal-abdominal drainage catheters. This article highlights the diagnostic challenges of bilothorax, a rare condition with non-specific and varied presentations, particularly in the absence of thoracic trauma.