Delayed bleeding due to a sharp protruding edge of the endostaplers after a wedge resection of the lung: a case report

Abstract

Background: Endoscopic devices often cause device-related surgical morbidities such as postoperative bleeding. Delayed bleeding due to a protruding edge of an endostapler has not been previously described in the literature. Case presentation: An 80-yr-old man with a second primary lung cancer underwent a wedge resection of the right lower lobe. He developed sudden hypotension and massive bleeding from the chest tube 4 h after the surgery and underwent an emergency reoperation. A torn parietal pleura was found to have caused a persistent bleeding. There was a sharp protruding edge created by multiple firings of the endostapler. The subsequent lung expansion would have promoted a direct contact between the edge and parietal pleura resulting in delayed bleeding. Conclusions: A protruding edge due to multiple firings of an endostapler could injure the parietal pleura and cause delayed bleeding after a lung resection. This type of injury would be more common in wedge resection cases because of the larger residual lung volume preserved, which is expected to have a better lung expansion and facilitate the direct contact of the staple line and parietal pleura.

Delayed cardiac tamponade caused by a staple line after wedge resection of the lung

“…Since there are some reports of postoperative bleeding due to staple malformations, we carefully checked the staple line and tried to remove malformed staples that may cause damage to other organs. However, as previously reported [ 3 ], the confluence of the lines tends to protrude, and lung expansion is likely to occur with partial resection alone. Therefore, tissue damage due to contact should have been considered.…”

Delayed postoperative bleeding following lobectomy caused by the sharp tip of a suture: a case report

“…Following partial resection, a larger residual lung volume remains compared to the residual lung volume that remains after lobectomy. Therefore, lung expansion to fill the intrathoracic cavity after partial resection happens sooner than in case of lobectomy, and early contact between surgical materials and the pleura occurs, resulting in immediate bleeding [4]. In the present case, we performed lobectomy to treat lung cancer.…”

“…The present case differed from other cases in terms of the delayed bleeding onset. Most cases of postoperative hemorrhage occur within 24 h of surgery and delayed bleeding is rare [2,4]. Early bleeding caused by staples in contact with the chest wall has often occurred following partial resection of the lung [2,4,5].…”

“…This short length prevented the thread from bending when it was vertically in contact with the parietal pleura. Therefore, the sutures should be short enough to avoid contact and should also be cut to prevent a sharp edge [4]. Regarding the material of the thread, we used non-absorbable sutures to stop the air leak.…”

“…Most cases of postoperative hemorrhage occur within 24 h of surgery and delayed bleeding is rare [ 2 , 4 ]. Early bleeding caused by staples in contact with the chest wall has often occurred following partial resection of the lung [ 2 , 4 , 5 ]. We considered that the difference in the bleeding onset in the present case was due to the proportion of the lung that was resected.…”