Lakeland Regional Health Medical Center Lakeland, FL
Omar Zuhdi, MD, Juan Rodriguez Padilla, MD, Paola Campillo, MD, Adeeb Mustafa, MD Lakeland Regional Health Medical Center, Lakeland, FL Introduction: Colopleural fistulas involve abnormal communication between the epithelial surfaces between the colon and pleura. They often present with respiratory symptoms including cough and dyspnea and can result in sepsis due to leakage of gastrointestinal content into the pleural space. Colopleural fistula and associated fecopneumothorax can have life-threatening complications, often requiring surgical intervention based on clinical and radiologic findings. Methods: A systematic literature search was conducted using PubMed, Scopus, and ScienceDirect to retrieve studies from inception up to May 2025. Studies describing patients with colopleural fistulas were included. According to PRISMA guidelines, two reviewers completed the initial title and abstract screening, full text review, and data extraction. A total of 12 papers were included in the study. Results: Among the included studies, the average age was 47.5 with a range of 18-88 years. 58.3% of patients (n=7) had colopleural fistulas associated with post-surgical causes, with the remainder of cases caused by diverticulosis (33.3%), colon cancer (16.6%), infection (16.6%), and Crohn’s disease (8.3%). The most common clinical symptom reported was dyspnea (58.3%), cough (50%), and fever (41.7%). In 66.7% of cases (n=10), left-sided colopleural fistulas were noted, with right sided colopleural fistulas noted in 16.7% of patients (n=2), with the remainder of cases not specified. Diagnostics used included chest x-ray, CT scan, barium enema, thoracentesis/pleural fluid analysis, and colonoscopy. Surgical intervention was used in 75% of cases; however, conservative therapy including antibiotic treatment and percutaneous drainage was used in 25% of cases. While most cases improved following surgical or conservative management, one patient death was reported due to fecopneumothorax secondary to colopleural fistula. The patient had presented with large amounts of black pleural fluid drained and colopleural fistula was diagnosed on autopsy. Discussion: Colopleural fistulas are a rare complication resulting in gastrointestinal content leakage into the pleural space which can result in various complications including empyema, subcutaneous emphysema, pneumothorax, and bacteremia. A variety of diagnostic modalities can be used to confirm colopleural fistulas including CT scan, barium enema, pleural fluid analysis, and colonoscopy. Because of the rarity of colopleural fistulas, diagnosis may be delayed resulting in an increased risk for adverse events.
Disclosures: Omar Zuhdi indicated no relevant financial relationships. Juan Rodriguez Padilla indicated no relevant financial relationships. Paola Campillo indicated no relevant financial relationships. Adeeb Mustafa indicated no relevant financial relationships.
Omar Zuhdi, MD, Juan Rodriguez Padilla, MD, Paola Campillo, MD, Adeeb Mustafa, MD. P4590 - Colopleural Fistulas - Risk Factors, Diagnostics, and Treatment: A Systematic Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
