One successful primary closure case of bronchopleural fistula after pneumonectomy by a new method

Abstract

One case of successful primary closure of a bronchopleural fistula (BPF) after right pneumonectomy by sealing from both inside the chest cavity and bronchus is reported. The patient was a 47-year-old man who underwent right pneumonectomy due to right lung total collapse and atelectasis which was long-term compressed by a huge cyst inside the right chest cavity. A BPF was found on day 20 after surgery. A thoracotomy approach was performed because it was difficult to find an appropriate location for close drainage. Once the effusion and bloody coagulum was cleaned up from the right chest cavity, it was still difficult to find the bronchial stump because of the thick pleural fibrous membranes, and no visible fistula was found. Inside the chest cavity, a bright spot could be seen when the bronchoscope was inserted to the right bronchial stump. Anastomotic glue (OB Glue) was smeared on the bright spot and NEOVEIL (Gunze Co., Tokyo, Japan) was used to cover and reinforce the area. Meanwhile OB Glue (Gzbme Co., Guangzhou, China) was placed on the bronchial stump by bronchoscope. Closed drainage was performed after the operation. The patient recovered well having an uncomplicated postoperative course and was discharged 7 days after the treatment. there is no such case reported before. Case presentationA 47-year-old male patient, who had short of breath and chest distress for 1 week and was found to have a mass in the chest cavity 5 years ago. Chest DR and CT scan (Figure 1) showed a huge cystic space-occupying lesion in the right chest cavity and the right lung was completely compressed. Diagnosis before surgery was considered as teratoma. The cyst located in the right pleural cavity occupied most of the cavity. Cyst resection was planned and severe adhesion (Figure 2A) to chest wall and right lung was found during the operation. About 3,000 mL of brown and nepheloid liquid was extracted from the cyst. Most of the right visceral pleura were cut off because of serious adhesion. The right lung was completely compressed and atelectatic with severe air leakage when the cyst was completely resected, so a right pneumonectomy was made to prevent pyothorax and further complications. The cyst is about 30 cm × 20 cm in size ( Figure 2B,C), and pathological diagnosis confirmed simple cyst. The patient was discharged on postoperative day (POD) 6 with anemia and hypoproteinemia because of personal reasons and was readmitted on POD 20 for serious cough with plenty kermesinus begma. At the time of admission, the patient had WBC 3,190/mL, ALB 3.4 g/dL, HBG 80g/L, height 171 cm, weight 55.7 kg, heart rate 87/min, blood pressure 122/66 mmHg, temperature 36.5℃, and SpO 2 97%. BPF was suspected and radioscopy revealed air and multiple encapsulated effusion in the right chest cavity with no obvious fistula was found between bronchial stump and chest cavity (Figure 3). The effusion was encapsulated and partly organized, so a thoracotomy was planned to clean up the right cavity because it was hard to find an appropriate position to...

Arterial reinforcement following pancreatoduodenectomy: The solution to prevent delayed hemorrhage caused by postoperative pancreatic fistula

“…Neoveil® is the brand name for PAS, which is marketed as a suture reinforcing material. In lung surgeries, some reports have shown that Neoveil® is useful in preventing air leakage by reinforcing the suture line 27–29 . Although our AR method also included FS, PAS alone could be effective in protecting the hepatic artery in patients with POPF.…”

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Transsternal occlusion of main bronchi fistulae after pneumonectomy

“…Пожалуй, самым грозным осложнением таких хирургических вмешательств остаются свищи главных бронхов. По сообщениям ряда авторов, частота их возникновения варьирует от 4,5 до 20%, а летальность составляет 25-75%, что обусловлено главным образом быстрым развитием гнойно-септических осложнений [2][3][4][5][6][7].…”

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