Successful surgical treatment of an intraoperatively ruptured lung abscess rupture using free pericardial fat implantation: a case report

Abstract

Background Lung abscess treatment results the treatment results improved with the development of antibiotics; however, surgical treatment is indicated when pyothorax is present, surgical treatment is indicated. When a lung abscess ruptures, pyothorax and fistula occur, which are difficult to treat. Case presentation A 74-year-old woman who experienced exacerbated dyspnea and left back pain for 10 days was diagnosed with a lung abscess caused by an odontogenic infection. The patient’s medical history included hypertension, angina pectoris, untreated dental caries, and periodontitis. Despite administration of meropenem for 5 days, inflammatory markers increased. Chest radiography revealed pleural effusion exacerbation; therefore, the patient immediately underwent chest drainage and surgery was planned. Thoracic debridement and parietal and visceral decortication were performed. However, the lung abscess in the lateral basal segment ruptured during visceral decortication. As the tissue was fragile and difficult to close with sutures, free pericardial fat was implanted in the ruptured abscess cavity and fixed with fibrin glue, and sutured to the abscess wall. No signs of postoperative air leakage or infection of the implanted pericardial fat were observed. All drainage tubes were removed by postoperative day 9. The patient was discharged on postoperative day 12 and underwent careful observation during follow-up as an outpatient. At 1 year and 2 months after surgery, empyema recurrence was not observed. Conclusions A lung abscess that ruptured intraoperatively was successfully and effectively treated by implantation of free pericardial fat in the abscess cavity.