Successful treatment of pyopneumothorax with bronchopleural fistula using endobronchial Watanabe spigots

Abstract

Bronchopleural fistula (BPF) can complicate necrotizing pneumonia. Surgery would be indicated in patients who fail conservative management, yet this group is often of poor pulmonary function and general condition. Bronchial occlusion with endobronchial Watanabe spigots (EWS) can be a potential alternative treatment when the culprit bronchi can be isolated. In this case report, we describe a middle-aged gentleman who presented with necrotizing pneumonia complicated with pyopneumothorax with right upper lobe BPF, and who had failed to respond to chest drainage and antibiotics. EWS bronchial occlusion finally led to cessation of air leak, allowing removal of chest tube. EWS were removed uneventfully six months later. This case highlights the role of EWS in the management of BPF in patients with high surgical risk.

Pyopneumothorax with bronchopleural fistula due to pulmonary infection caused by Porphyromonas gingivalis in a patient with periodontitis

“…conservative treatment is usually ineffective and surgical intervention is required. 4 In conclusion, this case report suggests that P. gingivalis can cause severe pulmonary infection and pyopneumothorax with bronchopleural fistula. A recent history of periodontitis is crucial information for clinical treatment.…”

“…This bacteria produces a various array of virulence factors, including capsule, lipoplysaccharide, proteolytic enzymes, and fimbriae, and rarely causes extraoral infection, but it once causes extraoral infection, which can lead to severe inflammation, tissue destruction, and sometimes abscess formation 3 . Pyopneumothorax with bronchopleural fistula is an infrequent complication of pulmonary infection 4 . Pyopneumothorax with bronchopleural fistula is characterized by the accumulation of pus and gas in the chest cavity.…”

Combined treatment with beaded EWS, Gore‐tex patch and N‐butyl‐2‐cyanoacrylate for bronchial fistula: The novel “sandwich method”

“…A BPF is a fistulous tract between the bronchus and the pleural space. It causes significant morbidity, with mortality rates of 18%–67% 3 . Permanent fenestration may be required when it is difficult to purify the empyema cavity and residual lung.…”

“…Recently, various endobronchial approaches have been used for the treatment of BPF. 2 , 3 Chai et al 3 reported that BPF was successfully treated using an endobronchial Watanabe spigot (EWS®, Novatech, LaCiotat, France), but it is sometimes dislodged and was repeatedly reinserted. Migration is the most common complication associated with endobronchial embolization using EWS.…”

Bronchoscopic treatment of bronchopleural fistula due to COVID-19

“…In similar cases, bronchoscopic occlusion of the leaking segment has been described including some innovative techniques. [ 2 3 4 5 6 ] However, none of these procedures have been done in COVID-19 patients. We present one such case where we were successful in treating the BPF by bronchoscopic treatment.…”