Should Empyema Space Be Surgically Closed?: A Case Report of Pleural Irrigation with Electrolyzed Saline for Postoperative Empyema

Abstract

Introduction: Acute empyema without bronchofistulae is now a well controllable disease by intrapleural irrigation with electrolyzed saline (ES), current ultimate disinfectant for biological tissues. ES irrigation was applied to postoperative empyema of esophagectomy, resulting hospital discharge without any surgical options. A 67 year old male with esophageal cancer had acute empyema in the right side, caused by anastomotic leaks, on postoperative day 7 after esophagectomy with neck lymphnode dissection reconstructed with gastric conduit through retrosternal route. He had catheter drainage with 2000 ml/day of ES irrigation for 20 days immediately after diagnosis of empyma. Pathogens were promptly eliminated, and empyema space was spontaneously closed. He had second empyema caused by gastric conduit rupture at the stapled line after 38 days of the cure in the first empyema. The patient had second ES irrigation under catheter indwell, and recovered for three weeks according to the spontaneous closure of the conduit leaks, and finally discharged our hospital after dilation of anastomotic stricture and swallowing rehabilitation. Conclusions: ES irrigation promptly controlled postoperative empyema of esophagectomy without surgical options for residual deadspace.