Successful treatment of post‐operative peripheral bronchopleural fistulas using endobronchial Watanabe spigots

Abstract

Post‐operative peripheral bronchopleural fistulas (BPF) are sometimes caused by post‐operative pneumonia and empyema. Conservative treatment options such as administration of antibiotics and chest tube drainage can have limited outcomes in certain cases. Bronchial occlusion is an effective treatment option if the target bronchi for BPF are identified. This case study describes a successful bronchial occlusion for peripheral BPF with endobronchial Watanabe spigots (EWSs) and a digital drainage system. This case involved a 70‐year‐old man who developed a post‐operative peripheral BPF after a left upper lobectomy. Bronchial occlusion with EWS was performed because the target bronchi responsible for BPF were clearly detected by a chest computerized tomography scan. The effectiveness of the occlusion was confirmed with the use of a digital drainage system immediately after the procedure was completed. The chest tube was removed one week following the bronchial occlusion procedure.

Successful treatment of pyopneumothorax with bronchopleural fistula using endobronchial Watanabe spigots

“…The key to success of endobronchial blockade is the localization and isolation of the culprit bronchus . During our initial balloon occlusion test, air leak ceased only when RUL bronchus was occluded but not the individual segmental bronchi, possibly due to the presence of collateral ventilation within the RUL segments or presence of multiple fistulae from all three segments of RUL.…”

Progress Report on Interventional Treatment for Bronchopleural Fistula

“…It may be a valid treatment option for empyema with multiple bronchopulmonary fistulae. In cases of postoperative peripheral BPF, if the target bronchus can be identified, the use of EWS and digital drainage systems (e.g., Thopaz) for peripheral BPF bronchial occlusion is an appropriate choice [ 62 ]. The occlusion technique involving a guide sheath (GS) and curette enables clear visual of EWS throughout the surgical process.…”

Bronchoscopic interventions for bronchopleural fistulas

“… 3 Other causes include necrotising infections such as pulmonary tuberculosis, pneumonia, empyema, chemotherapy or radiation therapy, and thoracic trauma. 4 , 5 …”

“…3 Other causes include necrotising infections such as pulmonary tuberculosis, pneumonia, empyema, chemotherapy or radiation therapy, and thoracic trauma. 4,5 The pleural cavity is a closed latent space containing a small amount of body fluid that acts as a lubricant during respiratory movement. When it comes into contact with the outside environment, prolonged fluid and air retention allow for bacterial invasion, resulting in the development of infections such as thoracic abscesses and mediastinitis.…”