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Murugesan C, Bai M, Pottakkat B, Dwivedi DP, Munuswamy H, Mohan P. Congenital bilio- bronchial fistula in an adult: a review of literature and video demonstration of laparoscopic fistula tract excision. J Minim Invasive Surg 2024; 27:1-11. [PMID: 38494180 PMCID: PMC10961235 DOI: 10.7602/jmis.2024.27.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 03/19/2024]
Abstract
This article presents a review of the literature on congenital bilio-bronchial fistula (BBF), a rare anomaly characterized by abnormal communication between the bile duct and respiratory tract. Congenital BBF often presents with bilioptysis in early neonates and infants; however, patients with no overt symptoms may occasionally present in adulthood. Our literature search in Medline from 1850 to 2023 revealed 42 reported cases of congenital BBF, primarily managed with thoracotomy and excision of the fistula tract. About one-third of these cases required multiple surgeries due to associated biliary anomalies. The review underscores the importance of diagnostic imaging, including bronchoscopy, in identifying and delineating the extent of the fistula. It also highlights the evolving surgical management, with recent cases showing the efficacy of minimally invasive approaches such as laparoscopy and thoracoscopy. In addition to the literature review, we report a young female patient with a history of recurrent respiratory infections presenting with bilioptysis and extensive left lung damage. Initial management included bronchoscopy-guided glue instillation, left thoracotomy, and pneumonectomy. Following the recurrence of symptoms, the patient was successfully treated with laparoscopic excision of the fistula tract. In recent times, minimally invasive approaches such as laparoscopy and thoracoscopy, with excision of the fistula tract are gaining popularity and have shown good results. We suggest biliary communication being the high-pressure end, tackling it transabdominal may prevent recurrent problems.
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Affiliation(s)
- Chandrasekar Murugesan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muniza Bai
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dharm Prakash Dwivedi
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Hemachandren Munuswamy
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pazhanivel Mohan
- Department of Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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2
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Atwi H, von Gizycki C, Ahmad S, DeCotiis C. Persistent air leak secondary to pneumothorax in COVID-19: A case report and review of literature. Respir Med Case Rep 2024; 47:101987. [PMID: 38283185 PMCID: PMC10811455 DOI: 10.1016/j.rmcr.2024.101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/17/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
An air leak is a pathologic communication between an area of the endobronchial tree and the pleural space, causing continued air flow. The communication can originate from a distal portion of the airway, causing an alveolar-pleural fistula, or from a more proximal airway, causing a bronchopleural fistula. When the air leak persists beyond 5-7 days, it is classified as persistent air leak (PAL). PAL has serious implications on patient management and outcomes, such as prolonged chest tube maintenance, high rate of infections, ventilation-perfusion mismatch, and prolonged hospital stay with higher morbidity and mortality. There are currently no guidelines for the management of PAL in COVID-19 patients. We presented a case of PAL in a patient with COVID-19-associated pneumothorax successfully treated with a one-way endobronchial valve. We also reviewed current published cases of PAL secondary to COVID-19-associated pneumothorax and the various methods they were treated. The first line treatment was insertion of one or more chest tubes, but the persistence of an air leak then led to other treatment modalities. Initial early surgical evaluation followed by pleurodesis is recommended for the management of PAL. The most common surgical approaches include VATS or open thoracotomy with mechanical or chemical pleurodesis or pleurectomy. However, surgery is not always a feasible option for critically ill patients. In such cases, there are multiple less invasive options for the management of PAL, including implantable devices, such as Watanabe spigots and stents, and chemical agents, such as thermal treatments, hemostatic substances, and tissue adhesives.
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Affiliation(s)
- Hanine Atwi
- Department of Internal Medicine, Morristown Medical Center, USA
| | | | - Syed Ahmad
- Department of Internal Medicine, Morristown Medical Center, USA
| | - Christopher DeCotiis
- Department of Pulmonary and Critical Care Medicine, Morristown Medical Center, USA
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3
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Kodaka N, Nakano C, Oshio T, Matsuse H. Lemierre syndrome complicated by bronchopleural fistula. J Postgrad Med 2024; 70:50-52. [PMID: 37376756 PMCID: PMC10947735 DOI: 10.4103/jpgm.jpgm_722_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 06/29/2023] Open
Abstract
We present a 19-year-old woman, a case of Lemierre syndrome, who presented with fever, sore throat, and left shoulder pain. Imaging revealed a thrombus in the right internal jugular vein, multiple nodular shadows below both pleura with some cavitations, right lung necrotizing pneumonia, pyothorax, abscess in the infraspinatus muscle, and multiloculated fluid collections in the left hip joint. After inserting a chest tube and administering urokinase for the pyothorax, a bronchopleural fistula was suspected. The fistula was identified based on clinical symptoms and computed tomography scan findings. If a bronchopleural fistula is present, thoracic lavage should not be performed as it may cause complications such as contralateral pneumonia due to reflux.
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Affiliation(s)
- N Kodaka
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - C Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - T Oshio
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - H Matsuse
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
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Yazawa T, Igai H, Kamiyoshihara M, Shirabe K. Right basal bronchial fistula due to amebic infection: a case report. BMC Pulm Med 2023; 23:117. [PMID: 37060007 PMCID: PMC10103523 DOI: 10.1186/s12890-023-02412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Pleuropulmonary amebiasis is the second most common form of extraintestinal invasive amebiasis, but cases that include bronchopleural fistula are rare. CASE PRESENTATION A 43-year-old male was referred to our hospital for liver abscess, right pleural effusion, and body weight loss. He was diagnosed with a bronchopleural fistula caused by invasive pleuropulmonary amebiasis and human immunodeficiency virus (HIV) infection. After initial medical treatment for HIV infection and invasive amebiasis, he underwent pulmonary resection of the invaded lobe. Intraoperative inspection revealed a fistula of the right basal bronchus in the perforated lung abscess cavity, but the diaphragm was intact. The patient was discharged on postoperative day 3 and was in good condition at the 1-year follow-up. CONCLUSIONS Clinicians should be aware that pleuropulmonary amebiasis can cause a bronchopleural fistula although it is very rare.
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Affiliation(s)
- Tomohiro Yazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22, Showa-Machi, Maebashi, 371-8511, Gunma, Japan.
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22, Showa-Machi, Maebashi, 371-8511, Gunma, Japan
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5
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Marzban-Rad S, Bozorgmehr R, Sattari P, Azimi G, Azimi A. Radical extrapleural pneumonectomy with bronchial fistula by pulmonary function test evaluation technique. Ann Med Surg (Lond) 2021; 72:103071. [PMID: 34840777 PMCID: PMC8605380 DOI: 10.1016/j.amsu.2021.103071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 10/24/2022] Open
Abstract
Introduction and importance: Pulmonary Function Tests (PFTS) is an important tool in the assessment of pulmonary pathologies and preoperative evaluation. Case presentation: A 54-year-old man with history of massive pleurisy in the left thorax, treated by placing chest tube and drainage of bloody effusion, was readmitted for epithelioid mesothelioma. He was then presented with pneumothorax due by a refractory bronchial fistula while having a plural catheter. Based on the consultation, the whole-body bone scan was conducted, and findings demonstrated epithelioid mesothelioma (stage 1) with the refractory fistula for which the patient was candidate for thoracic surgery. Decreased lung capacity was seen by Pulmonary Function Testing - PFTS. Clinical discussion The novel PFTS Evaluation Technique was designed to measure the true pulmonary capacities in order to evaluate the pulmonary post-operative tolerance. In this technique the chest tube was placed for 4 weeks until the patient reaches mediastinal fixation then the measurements by PFTS were carried out in two steps. First, using an open chest tube and second, using a clamped chest tube. In both steps, the pulmonary capacities were measured and provided to the pulmonologist for consultation. Conclusion In this case, after acquiring the approval of the specialist depended on PFTS after PFTS Evaluation Technique, the radical extra pleural pneumonectomy surgery was conducted, and the patient was discharged with a good general appearance and treated fistula.
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Affiliation(s)
- Saeid Marzban-Rad
- Department of Thoracic Surgery, Imam-Reza Hospital, Aja University of Medical Sciences, Tehran, Iran
| | - Rama Bozorgmehr
- Clinical Research Development Unit, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parastesh Sattari
- General Practitioner, Institute of Health Education and Research, Chamran Hospital, Tehran, Iran
| | - Ghasem Azimi
- Department of Internal Medicine, School of Medicine, Shahed University, Tehran, Iran
| | - Ali Azimi
- Student of Research Committee, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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6
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Lee SG, Lee SH, Park WK, Kim DH, Song JW, Cho SH. Recurrent Aorto bronchial Fistula after Endovascular Stenting for Infected Pseudoaneurysm of the Proximal Descending Thoracic Aorta: Case Report. J Chest Surg 2021; 54:425-428. [PMID: 33767025 PMCID: PMC8548198 DOI: 10.5090/jcs.20.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/05/2022] Open
Abstract
Aortobronchial fistula (ABF) induced by an infected pseudoaneurysm of the thoracic aorta is a life-threatening condition. As surgical treatment is associated with significant mortality and morbidity, thoracic endovascular aneurysm repair (TEVAR) may be an alternative for the treatment of ABF. However, the long-term durability of this intervention is largely unknown and the recurrence of ABF is a potential complication. We experienced a case of recurrent ABF after stent grafting as an early procedure for an infected pseudoaneurysm of the thoracic aorta. Remnant ABF, bronchial and/or aortic wall erosion, vasa vasorum connected with ABF, and recurrent local inflammation of the thin aortic wall around ABF might cause recurrent hemoptysis. As a result, we suggest that TEVAR should be considered as a bridge therapy for the initial treatment of ABF resulting from an infected pseudoaneurysm, and that several options, such as second-stage surgery, should be considered to prevent the recurrence of ABF.
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Affiliation(s)
- Sun-Geun Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hyong Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Won Kyoun Park
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dae Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang-Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Kang B, Myung Y. Treatment of chronic bronchopleural fistula and recurrent empyema using a latissimus dorsi myocutaneous flap: a case report and literature review. Arch Plast Surg 2021; 48:494-7. [PMID: 34583433 DOI: 10.5999/aps.2020.02516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/28/2021] [Indexed: 11/08/2022] Open
Abstract
Bronchopleural fistula is a severe complication with a high mortality rate that occurs after pulmonary resection. Several treatment options have been suggested; however, it is a challenge to treat this condition without recurrence or other complications. In this case report, we describe the successful performance of a pedicled latissimus dorsi myocutaneous flap transfer, with no recurrence or donor site morbidity.
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8
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Nobori Y, Sato M, Hirata Y, Yamauchi H, Konoeda C, Kitano K, Nakajima J. Intrabronchial migration of hemostatic agent through a bronchial fistula after lung transplantation: a case report. Surg Case Rep 2021; 7:116. [PMID: 33970364 PMCID: PMC8110655 DOI: 10.1186/s40792-021-01200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background A bronchial fistula is a relatively rare and potentially fatal complication after lung transplantation. Thoracic surgeons and pulmonologists often face challenges when selecting treatment options. We herein report an exceptional case of intrabronchial migration of a nonabsorbable hemostatic agent, which had been placed around the pulmonary artery at the time of lung transplantation, through a bronchial fistula. Case presentation A 61-year-old man developed respiratory distress 1 year after left single-lung transplantation for idiopathic interstitial pneumonia. Bronchoscopic examination revealed an apparent foreign body protruding from the mediastinum into the distal site of the bronchial anastomosis. The foreign body was easily removed bronchoscopically and appeared to be a hemostatic agent that had been placed during the previous lung transplantation. The patient developed a similar clinical episode and finally developed hemoptysis. Computed tomography revealed a foreign body located between the bronchus and pulmonary artery, partially protruding into the bronchial lumen. Given the possibility of a bronchopulmonary arterial fistula, surgical treatment was performed. The foreign body was located between the bronchus and left pulmonary artery and was easily removed. Multiple bronchial fistulas were found, and all were closed with direct sutures. Bypass grafting of the left pulmonary artery was then performed, initially with a homograft but eventually with an extended polytetrafluoroethylene graft. The patient was finally discharged 5 months after the surgery. Conclusion We experienced an extremely rare case of intrabronchial migration of hemostatic agents used during the previous lung transplantation through a bronchial fistula, which were successfully managed by direct bronchial closure and bypass grafting of the left pulmonary artery.
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Affiliation(s)
- Yuya Nobori
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yasutaka Hirata
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruo Yamauchi
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chihiro Konoeda
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kentaro Kitano
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Ammirabile A, Rizzo DA, Pedicini V, Lanza E. Percutaneous Treatment of Bronchobiliary Fistula: Report of a Successful Transhepatic Embolization and a Decision-Making Strategy Driven by Systematic Literature Review. Cardiovasc Intervent Radiol 2021; 44:1005-16. [PMID: 33928407 DOI: 10.1007/s00270-021-02837-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
Bronchobiliary fistula is a rare condition characterized by bile leaking into the bronchial tree causing biliptysis. It may arise from liver infection or as a consequence of resection and thermal ablation of cancer. Currently, there is no consensus about the treatment strategy. Surgery is considered the main therapy by most authors. However, this systematic literature review shows that the success rate of percutaneous treatments may reach 75%. Adding to such evidence, we also report the case of a woman affected by iatrogenic bronchobiliary fistula secondary to liver thermal ablation, successfully treated with percutaneous drainage plus embolization. Summarizing these results, we encourage the percutaneous management of bronchobiliary fistula by providing a 3-step decision-making algorithm, aimed at reducing the need for major surgery.
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10
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Makidono K, Miyata Y, Ikeda T, Tsutani Y, Kai Y, Kushitani K, Takeshima Y, Okada M. Bronchial mucosal ablation for bronchial stump closure in right pneumonectomy: a case report. J Med Case Rep 2021; 15:71. [PMID: 33596992 PMCID: PMC7890849 DOI: 10.1186/s13256-020-02652-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bronchial fistula is a severe complication of pneumonectomy with a high mortality rate. We previously reported a technique for bronchial closure to prevent bronchial fistula in a canine model. We described that mucosal ablation could result in primary wound healing and involve mucosal tight adhesions histologically. In this paper, the pathologic findings of one patient, who underwent autopsy 4 years after surgery, were reviewed. Case presentation A 70-year-old Japanese man was diagnosed with malignant pleural mesothelioma and underwent right extra-pleural pneumonectomy. The right main bronchus was cut using a scalpel. When closing the bronchial stump, the bronchial mucosa was ablated by electric cautery and sutured manually using 3-0 absorbable sutures. The bronchial fistula was not found after pneumonectomy. Four years after surgery, the patient died of recurrent malignant pleural mesothelioma and underwent autopsy. Macroscopic evaluation showed tight adhesions and white scars on the bronchial stump. Microscopic findings showed few inflammatory cells and α-smooth muscle actin (α-SMA)-positive cells. Conclusions The results from this case suggested that bronchial mucosal ablation leads to robust agglutination of bronchial stump over years. This technique is not only simple but also reliable to prevent bronchial fistula.
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Affiliation(s)
- Kimitaka Makidono
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Takuhiro Ikeda
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Yuichiro Kai
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Kei Kushitani
- Department of Pathology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Yukio Takeshima
- Department of Pathology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan.
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Aritake T, Higaki E, Abe T, Hara K, Suenaga Y, Kunitomo A, Oki S, Nagao T, Hosoi T, Ito S, Komori K, Shimizu Y. Bronchial fistula and esophageal stricture following endoscopic trans-gastric drainage for a mediastinal pancreatic pseudocyst. Clin J Gastroenterol 2021; 14:466-470. [PMID: 33598790 DOI: 10.1007/s12328-021-01361-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022]
Abstract
A 43-year-old man with alcoholic cirrhosis and chronic alcoholic pancreatitis was referred for evaluation of chest pain and an enlarging pleural effusion. Computed tomography revealed a bilateral pleural effusion and longitudinal multilocular pancreatic pseudocysts extending to the posterior mediastinum along the esophagus. He was diagnosed with a mediastinal pancreatic pseudocyst rupturing into the pleural cavity and was initially treated with endoscopic ultrasound-guided trans-gastric drainage. After 4 months of stable disease, dysphagia and a severe cough developed due to an esophageal stricture and main bronchial fistula. Considering the inadequate drainage, the trans-gastric drainage stent was surgically exchanged for a percutaneous external drain and the bronchial fistula was repaired using an intercostal muscle flap. After improvement of the mediastinal abscess and the symptoms, he was discharged on post-operative day 72. Two years post-operatively, he is in good health with no recurrence. We herein report a rare case of a bronchial fistula and esophageal stricture after endoscopic trans-gastric drainage of a mediastinal pancreatic pseudocyst. Endoscopic trans-gastric drainage is an effective treatment for mediastinal pancreatic pseudocysts, but it is important to provide appropriate alternative treatment depending on the course of treatment.
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Affiliation(s)
- Tsukasa Aritake
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan.
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Yasuhito Suenaga
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Aina Kunitomo
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Satoshi Oki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Takuya Nagao
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Takahiro Hosoi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
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Lee SG, Lee SH, Park WK, Kim DH, Song JW, Cho SH. Recurrent Aorto bronchial Fistula after Endovascular Stenting for Infected Pseudoaneurysm of the Proximal Descending Thoracic Aorta. J Chest Surg 2021. [PMID: 33767025 DOI: 10.5090/kjtcs.20.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aortobronchial fistula (ABF) induced by an infected pseudoaneurysm of the thoracic aorta is a life-threatening condition. As surgical treatment is associated with significant mortality and morbidity, thoracic endovascular aneurysm repair (TEVAR) may be an alternative for the treatment of ABF. However, the long-term durability of this intervention is largely unknown and the recurrence of ABF is a potential complication. We experienced a case of recurrent ABF after stent grafting as an early procedure for an infected pseudoaneurysm of the thoracic aorta. Remnant ABF, bronchial and/or aortic wall erosion, vasa vasorum connected with ABF, and recurrent local inflammation of the thin aortic wall around ABF might cause recurrent hemoptysis. As a result, we suggest that TEVAR should be considered as a bridge therapy for the initial treatment of ABF resulting from an infected pseudoaneurysm, and that several options, such as second-stage surgery, should be considered to prevent the recurrence of ABF.
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Affiliation(s)
- Sun-Geun Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hyong Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Won Kyoun Park
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dae Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang-Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Deng P, Hu C, Li Y, Cao L, Yang H, Li M, An J, Jiang J, Gu Q. Bronchial Fistula: Rare Complication of Treatment with Anlotinib. Zhongguo Fei Ai Za Zhi 2020; 23:858-865. [PMID: 32987493 PMCID: PMC7583880 DOI: 10.3779/j.issn.1009-3419.2020.102.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes. METHODS We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula." RESULTS Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months. CONCLUSIONS Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.
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Affiliation(s)
- Pengbo Deng
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Liming Cao
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Huaping Yang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jian An
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Juan Jiang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
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14
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Caushi F, Qirjako G, Skenduli I, Xhemalaj D, Hafizi H, Bala S, Hatibi A, Mezini A. Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula? J Cardiothorac Surg 2020; 15:248. [PMID: 32917252 PMCID: PMC7488725 DOI: 10.1186/s13019-020-01290-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.
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Affiliation(s)
- Fatmir Caushi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania. .,Department of Surgery, Our Lady of Good Counsel University, Tirana, Albania.
| | - Gentiana Qirjako
- Department of Public Health, University of Medicine, Tirana, Albania
| | - Ilir Skenduli
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Daniela Xhemalaj
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Hasan Hafizi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Silva Bala
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Alban Hatibi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Arian Mezini
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
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15
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Kynta RL, Sun N, Saikia MK. Muscle flaps in pulmonary infections: a case series from Northeast India. Asian Cardiovasc Thorac Ann 2020; 28:488-494. [PMID: 32762245 DOI: 10.1177/0218492320949074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Treatment of complications due to pulmonary infections usually involves lung resection with or without debridement. Managing residual intrathoracic defects, chronic empyema, and bronchopleural fistulae after such resections poses unique challenges. METHODS We retrospectively reviewed the data of all 9 patients referred to us with complications due to pulmonary infections, including the surgical procedures, flaps used, and their outcomes between 2018 and 2019. RESULTS The mean age of the patients was 30 years (range 9?48 years). The primary disease was tuberculosis in 6 (66%) patients. Complications of primary infections were pneumothorax (n = 3), auto-pneumonectomy (n = 2), organized empyema (n = 3), and recurrent hemoptysis (n = 1). Initial interventions included lobectomy (n = 2), tracheoesophageal repair (n = 1), bronchial artery embolization (n = 1), intercostal tube drainage (n = 4), and decortication(n = 1). Complications after primary interventions included bronchopleural fistula (n = 4, 45%), recurrent empyema (n = 3, 33%), tracheal stump dehiscence (n = 1, 11%) and non-resolving hemoptysis (n = 1, 11%). Pathological microorganisms were isolated in 8 (88%) patients. Secondary corrective surgical interventions along with pedicled muscle flap interposition and reinforcement were undertaken. Nine flap procedures with or without thoracoplasty were performed. There was no open thoracostomy conversion. There was one death postoperatively. CONCLUSION A locoregional pedicled flap with or without thoracoplasty is an effective option to manage complications of pulmonary infections. The cardiothoracic surgeon should have a knowledge of the locoregional flaps of the thorax and abdomen to address such complications.
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Affiliation(s)
- Reuben Lamiaki Kynta
- Department of Cardiothoracic and Vascular Surgery, 56918North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Neelamjingbha Sun
- Department of Cardiothoracic and Vascular Surgery, 56918North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Manuj Kumar Saikia
- Department of Cardiothoracic and Vascular Surgery, 56918North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
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16
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Kondo N, Hashimoto M, Takuwa T, Matsumoto S, Okumura Y, Hasegawa S. Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant. Gen Thorac Cardiovasc Surg 2020; 68:1562-1564. [PMID: 32279197 DOI: 10.1007/s11748-020-01349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Treatment options for bronchial fistula (BF) after pneumonectomy are often limited and carry significant morbidity and mortality. The patient underwent right extrapleural pneumonectomy for malignant pleural mesothelioma had BF without macroscopic fistula found by bronchography. We treated this minor BF using bronchoscopy with the administration of OK-432, fibroblast growth factor basic, and fibrin glue sealant. Two weeks after this treatment, we confirmed the improvement of the fistula by bronchography. Bronchoscopic therapy for BF was useful for a small, early fistula without infection.
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Affiliation(s)
- Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Teruhisa Takuwa
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Seiji Matsumoto
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshitomo Okumura
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.,Department of Thoracic Surgery, Itami Municipal Hospital, Hyogo, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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17
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Joh HK, Park SY. Surgical Treatment of Bronchobiliary Fistula with Pulmonary Resection and Omentopexy. Korean J Thorac Cardiovasc Surg 2020; 53:38-40. [PMID: 32090057 PMCID: PMC7006612 DOI: 10.5090/kjtcs.2020.53.1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022]
Abstract
Bronchobiliary fistula is a rare disease defined as an abnormal connection between the biliary tract and the bronchial tree. We report the successful surgical repair of bronchobiliary fistula. A 78-year-old man underwent surgery and several rounds of transcatheter arterial chemoembolization and radiofrequency ablation as treatment for hepatocellular carcinoma. He presented with greenish sputum and chronic cough for several months, and his symptoms did not resolve after endoscopic treatment. We performed lobectomy of the right lower lobe and omentopexy for bronchobiliary fistula under laparotomy and thoracotomy. The bronchobiliary fistula was successfully closed, and the bilious sputum disappeared after surgery.
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Affiliation(s)
- Hyon Keun Joh
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
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18
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Nagashima T, Ito H, Samejima J, Nemoto D, Eriguchi D, Nakayama H, Woo T, Masuda M. Postoperative changes of the free pericardial fat pad for bronchial stump coverage. J Thorac Dis 2020; 11:5228-5236. [PMID: 32030240 DOI: 10.21037/jtd.2019.11.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Bronchopleural fistula (BPF) remains a serious complication after surgery for lung cancer with bronchial resection. A free pericardial fat pad (FPFP) is applied in high-risk cases to reduce BPF frequency. BPF may occur 6 months after surgery. Thus, we evaluated the residual FPFP volume at 6 months after surgery to estimate the residual FPFP ratio and determine the amount of FPFP to be harvested during surgery. Methods We retrospectively investigated 40 patients who underwent lobectomy with bronchial stump coverage using FPFP. During surgery, the volume of the harvested FPFP was measured and the FPFP was affixed to the bronchial stump. Further, 6 months after surgery, the residual volume of the installed FPFP was analyzed using a three-dimensional volume analyzer and the residual ratio was calculated. We also evaluated clinicopathological factors influencing the resected FPFP and residual ratio. Results The median resected FPFP volume was 11 [3-40] mL. During multivariate analysis, body mass index and surgical approach were found to be significant factors associated with the resected FPFP volume. The median residual FPFP volume was 4.3 (0.4-15.5) mL. The median residual ratio was 0.39 (0.13-0.66). The resected FPFP volume was significantly associated with the residual volume (P<0.001) but not with the residual ratio (P=0.811). No factor was associated with the residual ratio. Conclusions In all cases, residual FPFP was confirmed at 6 months after surgery and the residual ratio was 40%. It is necessary to determine the volume of FPFP to be harvested while carefully considering the shrinkage ratio.
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Affiliation(s)
- Takuya Nagashima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daiji Nemoto
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daisuke Eriguchi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tetsukan Woo
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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19
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Hicham H, Ibrahim I, Rabiou S, Marouane L, Yassine O, Mohamed S. Postpneumonectomy empyema: risk factors, prevention, diagnosis, and management. Asian Cardiovasc Thorac Ann 2019; 28:89-96. [PMID: 31865750 DOI: 10.1177/0218492319888048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Postpneumonectomy empyema is a collection of pus in the pleural space after removal of the underlying lung. Postpneumonectomy empyema is a serious complication responsible for high rates of morbidity and mortality. Several risk factors for the development of postpneumonectomy empyema have been highlighted in the literature. The association of postpneumonectomy empyema with a bronchopleural fistula increases the rate of mortality by flooding the remaining lung. The management of postpneumonectomy empyema depends on the timing of presentation and the presence or absence of a bronchopleural fistula. The goals of care in the acute period are mainly preservation of the contralateral lung and sterilization of the pleural space, which may take a considerable time. The aims in the late period are closure of the bronchopleural fistula, obliteration of the pleural space, and closure of the chest wall.
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Affiliation(s)
| | | | - Sani Rabiou
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
| | - Lakranbi Marouane
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Ouadnouni Yassine
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Smahi Mohamed
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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20
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Makidono K, Miyata Y, Ikeda T, Tsutani Y, Kushitani K, Takeshima Y, Okada M. Investigation of surgical technique for bronchial stump closure after lobectomy in animal model. Gen Thorac Cardiovasc Surg 2019; 68:609-614. [PMID: 31858404 DOI: 10.1007/s11748-019-01265-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Bronchial fistulae following lung surgery are associated with high mortality. We examined the histological effects of mucosal ablation as a technique for closing bronchial stumps to prevent bronchial fistulae in an animal model. METHODS Left lower lobectomy was performed in beagles under general anesthesia. The bronchial stumps were closed using one of the following four methods: (A) manual suturing using 3-0 absorbable sutures, (B) ablation of bronchial mucosa with electric cautery and manual sutures, (C) stapling and reinforcement with manual sutures, or (D) ablation and stapling followed by reinforcement with manual sutures. Bronchial stumps were histologically evaluated on postoperative day 14. RESULTS No bronchial fistulae were noted in the animals during the observation period. Histologically, there were no adhesions between the bronchial mucosae at the suture and staple lesions in groups A and C. The bronchial mucosae were adherent at the ablation sites in groups B and D. Inflammatory cells, myofibroblasts, and neovascular vessels were abundant around the ablated lesions. CONCLUSIONS Bronchial mucosal ablation may play a key role in mucosal adhesion and tight union of the bronchial stump.
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Affiliation(s)
- Kimitaka Makidono
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Takuhiro Ikeda
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Kei Kushitani
- Department of Pathology, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8553, Japan.
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21
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Gabryel P, Piwkowski C, Gąsiorowski Ł, Zieliński P. The role of indocyanine green fluorescence in bronchopleural fistula prevention. Asian Cardiovasc Thorac Ann 2019; 28:68-70. [PMID: 31830420 DOI: 10.1177/0218492319896512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 57-year-old woman with non-small-cell lung cancer qualified for pneumonectomy. At the start of the surgery, a pedicled intercostal muscle flap was harvested. Indocyanine green fluorescence revealed ischemia in the distal part of the flap. After pneumonectomy, the ischemic portion of the muscle was removed and the well-perfused proximal part was sutured to the bronchial stump. Reassessment with indocyanine green showed good perfusion of the flap. The postoperative period was uneventful, but follow-up bronchoscopy revealed bronchial suture line dehiscence with the muscle flap separating the bronchial lumen from the postpneumonectomy space. The bronchial stump healed spontaneously by secondary intention.
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Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Gąsiorowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Pawel Zieliński
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
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22
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Rodriguez-Ruiz E, Barral-Segade P, Fernández-González ÁL, Prim JMG, Galbán Rodríguez C. Venovenous extracorporeal membrane oxygenation as a bridge to traumatic bronchial fistula closure. ACTA ACUST UNITED AC 2019; 66:533-6. [PMID: 31601431 DOI: 10.1016/j.redar.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 11/20/2022]
Abstract
Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient.
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Abstract
Background The intrathoracic transposition of the omentum (ITO) has been reported with more or less good results in various clinical circumstances but with no clear guidelines or indications. Methodology and review This article reviews the main clinical situations in which omento-plasty (OP) may be taken into consideration by the thoracic surgeons: mediastinitis and deep sternal infections after median sternotomy, reinforcement of the eso-gastric anastomosis after esophagectomy, prevention and treatment of the bronchial fistula after pulmonary resection, space-filling procedures for empyema, mediastinal tracheostomy, management of the infected intrathoracic vascular grafts / ventricular assist devices and heart OP. For each clinical situation we have performed a literature review with analysis of the most relevant published papers searching for an evidence-based approach for the use of the ITO/OP in thoracic surgery. Conclusions OP may be an elegant solution for a wide range of problems in thoracic surgery. In the published literature, there are mainly case-reports and relatively small series published resulting in a low level of evidence for both ITO as a surgical technique by itself, as well as for the use of OP in various clinical situations involving the chest structures. The indications for its use in thoracic surgery are based more on common sense and the lack of other solutions.
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Affiliation(s)
- Petre V H Botianu
- Surgery IV Discipline, M5 Department, University of Medicine and Pharmacy from Tirgu-Mures, 540091 Bujorului 2A, Tirgu-Mures, Romania.
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24
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Bashenow AV, Motus IY, Tsvirenko AS, Medvinskiy ID, Dovbnya SA, Dotsenko IA. Right main bronchus para-occluder fistula closure with a septal defect occluder. Asian Cardiovasc Thorac Ann 2019; 27:505-508. [PMID: 31142124 DOI: 10.1177/0218492319854240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case of successful closure of a para-occluder fistula. The bronchopleural fistula occurred after a right-sided pneumonectomy performed for multidrug-resistant tuberculosis. Initial closure of the bronchopleural fistula with the use of an atrial septal defect occluder 3 years later led to relapse of the fistula after 2 years. To manage the relapsing bronchopleural fistula, we partially destroyed the former nonfunctioning occluder, measured the size of the bronchial defect with a sizing balloon, and installed an atrial septal defect occluder of a larger size.
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Affiliation(s)
| | - Igor Yakovlevich Motus
- 1 Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Anna Sergeevna Tsvirenko
- 3 Department of Diagnostic Radiology, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Igor Davydovich Medvinskiy
- 2 Intensive Care Unit, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Sergey Alexandrovich Dovbnya
- 1 Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Ivan Alexandrovich Dotsenko
- 4 Department of Neurosurgery, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
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25
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Harmouchi H, Sani R, Belliraj L, Ammor F, Issoufou I, Lakranbi M, Ouadnouni Y, Smahi M. Pneumonectomy for non-tumoral diseases: etiologies and follow-up in 38 cases. Asian Cardiovasc Thorac Ann 2019; 27:298-301. [PMID: 30808191 DOI: 10.1177/0218492319834823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pneumonectomy is a surgical procedure associated with high rates of morbidity and mortality. Chronic inflammatory pathologies increase these rates, depending on the degree of pleural symphysis and the underlying pulmonary pathology. The occurrence of a bronchopleural fistula after pneumonectomy remains of great concern to the thoracic surgeon, because it leads to empyema in the pneumonectomy cavity, which requires protracted and difficult management. METHODS A retrospective single-center study was carried out on 38 patients who underwent pneumonectomy for non-tumoral pathologies between 2010 and 2017. Of the 38 patients, 22 (57.8%) men and 16 (42.2%) women, the average age was 40.3 years, and 30 (79%) patients were treated for tuberculosis. RESULTS The symptoms were predominantly hemoptysis with bronchorrhea in 22 (57.9%) cases. Chest computed tomography showed right-sided involvement in 15 (39.5%) patients, with destroyed lung in 31 (81.5%). Early postoperative complications included bleeding in 11 (28.9%) patients, postpneumonectomy empyema in 4 (10.5%), and death in 2 (5.2%). The average duration of follow-up was 2 years, without any recurrence. CONCLUSION The endemicity of tuberculosis in our context, and the absence of screening for lung cancer, explain the frequency of pneumonectomy for chronic inflammatory diseases, and the rate of complications after this surgical procedure.
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Affiliation(s)
- Hicham Harmouchi
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Rabiou Sani
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Layla Belliraj
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Fatimazahra Ammor
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Ibrahim Issoufou
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco
| | - Marouane Lakranbi
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco.,2 Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Yassine Ouadnouni
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco.,2 Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Mohammed Smahi
- 1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco.,2 Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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26
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Rivo E, Quiroga J, García-Prim JM, Obeso A, Soro J, Oseira A, Golpe A. Bronchoscopic sclerosis of post-resectional bronchial fistulas. Asian Cardiovasc Thorac Ann 2018; 27:93-97. [PMID: 30525867 DOI: 10.1177/0218492318818965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary resection is, by far, the primary cause of bronchial fistula. This is a severe complication because of its morbidity and mortality and the related consumption of resources. Definitive closure continues to be a challenge with several therapeutic options, but none are optimal. We describe our experience in bronchoscopic application of ethanolamine and lauromacrogol 400 for the treatment of post-resection bronchial fistulas. METHODS Clinical records of 8 patients treated using this technique were collected prospectively. The diagnosis of a fistula was confirmed by flexible bronchoscopy. Sclerosis was indicated in the context of multimodal treatment. Sclerosant injection was performed under general anesthesia with a Wang 22G needle through a flexible bronchoscope. The procedure was repeated at 2-week intervals until definitive closure of the fistula was confirmed. RESULTS Fistula closure was achieved in 7 (87.5%) of the 8 patients, with persistence of the fistula in one patient who could not complete the treatment because of recurrence of his neoplastic pathology. No recurrence or complications related to the technique were registered. CONCLUSIONS Bronchoscopic sclerosis by means of submucosal injection of lauromacrogol 400 or ethanolamine should be part of the multimodal treatment of bronchopleural fistula after lung resection, pending further studies that contribute to the accurate establishment of optimal indications for this procedure.
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Affiliation(s)
- Eduardo Rivo
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Jorge Quiroga
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - José-María García-Prim
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Andrés Obeso
- 3 Thoracic Surgery Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jose Soro
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Anaí Oseira
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Antonio Golpe
- 2 Pulmonology Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
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Bi Y, Li J, Yu Z, Ren J, Wu G, Han X. Metallic small y stent placement at primary right carina for bronchial disease. BMC Pulm Med 2018; 18:182. [PMID: 30497447 PMCID: PMC6267810 DOI: 10.1186/s12890-018-0742-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Metallic large Y stent placement has been used mainly for airway disease around the main carina. However, few studies have reported this treatment for bronchial disease around the primary right carina. Methods Twenty-eight patients were treated by small y stent. All stents were custom-designed and placed under fluoroscopic guidance. Clinical and imaging data were analyzed retrospectively. Results Thirty-one stents were successfully inserted in 28 patients. Twenty-five patients succeed at the first attempt (89.3%), and 3 patients needed a second attempt. Twelve complications occurred in 10 patients (35.7%). Stent restenosis and sputum retention were the most common complications. Five patients underwent successful stent removal due to complications or cure efficacy. During follow up, 17 patients died of tumors and one died of myocardial infarction. The 1-, 3-, and 5-year survival rates were 49.3, 19.6 and 19.6%, respectively. Conclusions Metallic small y stent placement is technically feasible, effective and safe for bronchial disease around the primary right carina.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jindong Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zepeng Yu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Wu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Xinwei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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28
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Endoh M, Oizumi H, Kato H, Suzuki J, Watarai H, Hamada A, Suzuki K, Nakahashi K, Shiono S, Sadahiro M. Hyperbaric oxygen therapy for postoperative ischemic bronchitis after resection of lung cancer. J Thorac Dis 2018; 10:6176-6183. [PMID: 30622789 DOI: 10.21037/jtd.2018.10.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hyperbaric oxygen therapy (HBOT) has been used successfully in the treatment of specific ischemic injuries, but has been a little evaluated specifically in postoperative ischemic bronchitis (POIB). The purpose of this study was to evaluate the effect of HBOT when used for POIB after resection of lung cancer. Methods From January 1999 to December 2016, 1,100 patients underwent lymph node dissection (LND) and either anatomic pulmonary resection or lung resection with bronchoplasty for lung cancer. POIB was diagnosed by bronchoscopy. HBOT was administered after POIB was diagnosed. HBOT comprised one 60-minute session daily in the hyperbaric chamber at 2.0 absolute atmospheres with 100% oxygen. We retrospectively analyzed the clinical course, timing of onset of POIB, outcomes, and any adverse events. Results Seven patients were identified to have had POIB treated with HBOT, all of whom were men with a smoking history and a median age of 65 years (range, 57-72 years). The operative procedures included three lung resections with bronchoplasty, three right lower lobectomies, and one right middle lobectomy performed owing to torsion of the middle lobe after right upper sleeve lobectomy. All 7 patients underwent subcarinal LND. POIB was diagnosed at a median of 11 days (range, 4-41 days) postoperatively. The median duration of an HBOT session was 7 days (range, 3-11 days). POIB resolved in 5 patients but worsened in 2, both of whom required further surgery. Conclusions Prospective clinical trials are now needed to confirm the potential benefits of HBOT in POIB.
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Affiliation(s)
- Makoto Endoh
- General Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata City, Yamagata Prefecture, Japan.,Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Hiroyuki Oizumi
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Hirohisa Kato
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Jun Suzuki
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Hikaru Watarai
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Akira Hamada
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Katsuyuki Suzuki
- General Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata City, Yamagata Prefecture, Japan
| | - Kenta Nakahashi
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Satoshi Shiono
- General Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata City, Yamagata Prefecture, Japan
| | - Mitsuaki Sadahiro
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
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Ono CR, Tedde ML, Scordamaglio PR, Buchpiguel CA. Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula. Radiol Bras 2018; 51:385-390. [PMID: 30559556 PMCID: PMC6290752 DOI: 10.1590/0100-3984.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Objective To evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF). Materials and Methods Nine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera. Results In two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy. Conclusion We found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.
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Affiliation(s)
- Carla Rachel Ono
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Paulo Rogerio Scordamaglio
- Respiratory Endoscopy Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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30
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Kawamoto N, Anayama T, Okada H, Hirohashi K, Miyazaki R, Yamamoto M, Kume M, Orihashi K. Indocyanine green fluorescence/thermography evaluation of intercostal muscle flap vascularization. Thorac Cancer 2018; 9:1631-1637. [PMID: 30264917 PMCID: PMC6275828 DOI: 10.1111/1759-7714.12871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 11/28/2022] Open
Abstract
Background During anatomical lung resection in high‐risk patients, the bronchial stump is covered with tissue flaps (e.g. pericardial fat tissue and intercostal muscle) to prevent bronchopleural fistula development. This is vital for reliable reinforcement of the bronchial stump. We evaluated the blood supply of the flap using indocyanine green fluorescence (ICG‐FL) and thermography intraoperatively in 27 patients at high risk for developing a bronchopleural fistula. Methods Before reinforcing the stump with a flap, the fluorescence agent was intravenously injected and the blood supply was evaluated. The surface temperature of the flap was measured with thermography. The two modalities were then compared. Results ICG‐FL intensity and surface temperature on the distal compared to the proximal side of the flap decreased by 32.6 ± 29.4% (P < 0.0001) and 3.5 ± 2.0°C (P < 0.0001), respectively. In patients with a higher ICG‐FL intensity value at the tip than the median, the surface temperature at the tip decreased by 2.7 ± 1.7°C compared to the proximal side. In patients with a lower ICG‐FL value at the tip, the surface temperature decreased by 4.6 ± 1.7°C (P = 0.0574). The bronchial stump reinforced the part of the flap with adequate blood supply; none of the patients developed a bronchopleural fistula. Conclusions ICG‐FL confirmed variation in the blood supply of the intercostal muscle flap, even if prepared using the same surgical procedure. Thermography analysis tends to correlate with the fluorescence method, but may be influenced by the state of flap preservation during surgery.
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Affiliation(s)
- Nobutaka Kawamoto
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Takashi Anayama
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hironobu Okada
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kentaro Hirohashi
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Ryohei Miyazaki
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Marino Yamamoto
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Motohiko Kume
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kazumasa Orihashi
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
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Abstract
Background Aerodigestive fistulae can be defined as abnormal communications between the gastrointestinal tract and the respiratory tract. Choking after meals, coughing, feeding difficulties, tachycardia, and persistent pneumonia are the main presentations. The aim of our study was to review our experience in the management of 27 cases of acquired aerodigestive fistulae of different types, levels, and management. Methods We conducted a retrospective observational study on 27 cases of fistulae between the respiratory and digestive tracts, which were managed in 2 hospitals in Saudi Arabia in the last 5 years. The patients comprised 16 females and 11 males, with a mean age of 29 years (range 17-67 years). Results The most common aerodigestive tract fistula was tracheoesophageal in 8 patients, followed by esophagobronchial in 6, and esophagopleural in 5. Four postendoscopic fistulae were included. The least common were gastropleural and esophagopulmonary fistulae. The most common etiologies were iatrogenic and esophageal cancer, and the least common was blunt chest trauma. The main presentations were fever, chocking after or during meals, and tachycardia. We used various modalities of treatment: conservative, cervical repair, thoracoabdominal repair, hybrid insertion of a T-tube, endoscopic esophageal stenting, and endoscopic clipping of the fistulous tract. During follow-up, 6 patients died due to advanced esophageal cancer in 5 and upper airway obstruction after iatrogenic tracheobronchial fistula in one. Conclusion Acquired aerodigestive fistula is a devastating condition that should be managed early and aggressively by a multidisciplinary team.
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Affiliation(s)
| | - Lamees A Maghrabi
- 2 Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
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32
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Mauduit M, Rouze S, Turner K, de Latour B, Verhoye JP. Combined thoracic and hepatobiliary surgery for iatrogenic bronchobiliary fistula. Asian Cardiovasc Thorac Ann 2017; 26:63-66. [PMID: 29172644 DOI: 10.1177/0218492317745747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bronchobiliary fistula is a rare pathology mainly caused by hepatic tumors, bile duct obstruction, or hepatic hydatid disease. A 70-year-old man developed a bronchobiliary fistula after biliary stenting. After failure of conservative treatment including endoscopic retrograde biliary drainage, he underwent a combined operation with a two-level approach. Both a thoracotomy and laparotomy were performed, allowing pulmonary resection, diaphragmatic repair, and bile duct reconstruction during the same operation. Postoperative follow-up at one year showed optimal healing of the fistula.
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Affiliation(s)
- Marion Mauduit
- 1 Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Simon Rouze
- 1 Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Kathleen Turner
- 2 Department of Gastrointestinal and Hepatic Surgery, Rennes University Hospital Center, Rennes, France
| | - Bertrand de Latour
- 1 Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Jean-Philippe Verhoye
- 1 Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
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33
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Simal I, García-Casillas MA, Cerdà J, Pérez L, Fernández B, De la Torre M, Fanjul M, Molina E, De Agustín JC. [Pleural cavity concerns]. Cir Pediatr 2017; 30:121-125. [PMID: 29043687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Persistent air leak (PAL) is a common problem. We asses our experience in the management of these patients. MATERIAL AND METHODS Retrospective review of patients with chest tubes after bronchopulmonary pneumothorax (due to lung resections, spontaneous pneumothorax, necrotizing pneumonia) from 2010 to 2015. We studied clinical data, PAL incidence, risk factors and treatment, considering PAL ≥ 5 days. RESULTS Thirty-seven cases (28 patients) between 0-16years: 26 lung resections, 11 pneumothorax. We found no differences in the distribution of age, weight, indication or comorbidity, but we noticed a trend to shorter hospital stay in infants. Patients with staple-line reinforcement presented lower PAL incidence than patients with no mechanical suture (43% vs 37%), the difference is even apparent when applying tissue sealants (29% vs 50%) (p > 0.05). We encountered no relationship between the size of the tube (10-24 Fr) or the type of resection, with bigger air leaks the higher suction pressure. We performed 13 pleurodesis in 7 patients (2 lobectomies, 3 segmentectomies and 2 bronchopleural fistulas), with 70% effectiveness. We conducted 7 procedures with autologous blood (1.6 ml/kg), 2 with povidone-iodine (0.5 ml/kg), 2 mechanical thoracoscopic and 2 open ones. We repeated pleurodesis four times, 3 of them after autologous blood infusion: 2 infusions with the same dose (both effective) and the other 2 as thoracotomy in patients with bronchopleural fistulas. After instillation of blood 3 patients presented with fever. After povidone-iodine instillation, the patient suffered from fever and rash. CONCLUSIONS Intraoperative technical aspects are essential to reduce the risk of PAL. Autologous blood pleurodesis, single or repeated, is a minimal invasive option, very safe and effective to treat the parenchymatous PAL.
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Affiliation(s)
- I Simal
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - M A García-Casillas
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - J Cerdà
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - L Pérez
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - B Fernández
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - M De la Torre
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - M Fanjul
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - E Molina
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
| | - J C De Agustín
- Servicio de Cirugía Pediátrica. Hospital General Universitario Gregorio Marañón. Madrid
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Lee K, Song JE, Jeong HS, Kim DY. [Hepato bronchial Fistula and Lung Abscess after Transarterial Chemoembolization]. Korean J Gastroenterol 2017; 69:316-320. [PMID: 28539038 DOI: 10.4166/kjg.2017.69.5.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Transarterial chemoembolization (TACE) is a common treatment modality to locally manage hepatocellular carcinoma. Liver abscess and bile duct injury are common complications of TACE. However, hepatobronchial fistula is a rare complication. Herein, we report a case of lung abscess due to hepatobronchial fistula after TACE. A 67-year-old man, who had underwent TACE 6 months ago, presented cough and bile-colored sputum. He was diagnosed with lung abscess and hepatobronchial fistula. We performed endoscopic retrograde cholangiopancreatography; however, there was no improvement in his symptoms. Thereafter, partial hepatectomy and repair of fistula were successively conducted.
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Affiliation(s)
- Kwanjoo Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Song
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyang Sook Jeong
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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35
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Kim JH, Kwon CI, Rho JY, Han SW, Kim JS, Shin SP, Song GW, Hahm KB. Communicating Tubular Esophageal Duplication Combined with Bronchoesophageal Fistula. Clin Endosc 2016; 49:81-5. [PMID: 26855929 PMCID: PMC4743716 DOI: 10.5946/ce.2016.49.1.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/30/2015] [Accepted: 06/08/2015] [Indexed: 01/07/2023] Open
Abstract
Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF.
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Affiliation(s)
- Ju Hwan Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Young Rho
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Woo Han
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Su Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Suk Pyo Shin
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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36
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Lee S, Lee K, Ko JK, Park J, Yu MY, Oh CK, Hong SP, Kim Y, Lim Y, Kim H, Pai H. Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with Tuberculous Lymphadenitis. Infect Chemother 2015; 47:261-7. [PMID: 26788411 PMCID: PMC4716279 DOI: 10.3947/ic.2015.47.4.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 11/24/2022] Open
Abstract
Purulent pericarditis is a rare condition with a high mortality rate. We report a case of purulent pericarditis subsequently caused by Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis in a previously healthy 17-year-old boy with mediastinal tuberculous lymphadenitis. The probable route of infection was a bronchomediastinal lymph node-pericardial fistula. The patient improved with antibiotic, antifungal, and antituberculous medication in addition to pericardiectomy.
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Affiliation(s)
- Seung Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kanglok Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jun Kwon Ko
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jaekeun Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Yeon Yu
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Kyo Oh
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Pyo Hong
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yeonjae Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Younghyo Lim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyuck Kim
- Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Yamamoto S, Endo S, Minegishi K, Shibano T, Nakano T, Tetsuka K. Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula. Asian Cardiovasc Thorac Ann 2015; 23:931-6. [PMID: 26187458 DOI: 10.1177/0218492315594071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative bronchopleural fistula is one of the most life-threatening complications after anatomical pulmonary resection. Bronchopleural fistula may cause empyema and aspiration pneumonia with subsequent acute respiratory distress syndrome. Surgical interventions for bronchopleural fistula can prolong hospitalization and impair postoperative quality of life. Postoperative care requires minimally invasive endoscopic occlusion. METHODS We retrospectively reviewed the records of 7 patients who developed bronchopleural fistula among 689 patients who underwent segmentectomy or lobectomy without sleeve resection for lung cancer in Jichi Medical University from 2009 to 2013. Bronchopleural fistula occurred in the right lower bronchial stump in 3 patients, in the superior segmental bronchus of the right lower lobe in 2, in the superior segmental bronchus of the left lower lobe in one, and in the right intermediate bronchus in one. Flexible bronchoscopy was used to occlude 3-mm fistulas with polyglycolic acid mesh in 2 patients. Larger fistulas in 5 patients were occluded with polyglycolic acid mesh plus fibrin glue to secure the mesh. The median procedure was 37 min. Procedures were considered complete upon resolution of air leakage from the chest drainage system. RESULTS Bronchoscopic interventions for bronchopleural fistula were repeated an average of 2 times. No procedure-related complications or death occurred. Bronchoscopic interventions were successful in all patients. CONCLUSIONS Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula.
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Affiliation(s)
- Shinichi Yamamoto
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoki Shibano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoyuki Nakano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kenji Tetsuka
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Abstract
We describe a bronchoscopic technique for closing small postoperative bronchopleural fistulas, using an oxidized regenerated cellulose patch and fibrin glue. The patch is mounted on the end of endoscopic forceps and introduced into the fistula to cover it. Intracavitary and submucosal injections of fibrin glue fill the bronchial stump and achieve apposition of the fistula edges. Closure was obtained in 3 of 4 patients; the 4th had complete bronchial dehiscence and empyema.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | | | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
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Park JS, Eom JS, Choi SH, Kim YH, Kim EK. Use of a serratus anterior musculocutaneous flap for surgical obliteration of a bronchopleural fistula. Interact Cardiovasc Thorac Surg 2015; 20:569-74. [PMID: 25636324 DOI: 10.1093/icvts/ivv005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/27/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Successful management of post-resection bronchopleural fistula (BPF) is a challenge, and various loco-regional flaps have been used to directly cover or to enhance closure of the bronchial stump. The serratus anterior muscle (SAM) is one of the workhorse flaps, although its use as a musculocutaneous flap has been debated. Here, we present our early experience with serratus anterior musculocutaneous (SAMC) flaps for the obliteration of BPF. METHODS A retrospective review of patients with surgical management of BPF from April 2005 to June 2014 was performed. A de-epithelized SAMC flap has replaced the conventional SAM flap since August 2013. Nine of consecutive former SAM flaps and 5 consecutive later SAMC flaps were identified. A detailed review of the SAMC flap cases was performed to describe medical and surgical history, BPF diagnosis and location, and the outcome of the flap surgery. RESULTS All five BPFs treated by SAMC flap were greater than 1 cm in diameter and all occurred on the right side. The leading primary diagnosis of a BPF was lung cancer, and the 4 lung cancer patients all underwent previous irradiation. The average size of the skin paddle was 19 × 6.6 cm(2), and the average volume of the skin paddle was 100.3 cm(3). Recurrence of the BPF was noted in 1 patient 6 weeks after surgery. In 4 of 5 patients, viable adipose tissue was confirmed by computed tomography scans. CONCLUSIONS The SAMC flap holds merits of a local flap such as short operation time, relative safety, no need of position change and faster recovery, with increased freedom of flap transfer and additional volume, thus widening surgical indication of the large, recalcitrant BPFs. We suggest that the SAMC flap could be safely harvested and used for management of a BPF or similar intrathoracic lesion when extensive flap length or bulk is required.
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Affiliation(s)
- Joo Seok Park
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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40
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Abstract
A 41-year-old male smoker presented with choking and coughing up food associated with repeated vomiting. Four years previously, following recurrent episodes of pancreatitis, he required percutaneous necrosectomy. He subsequently had a cholecystectomy and mesh repair of the abdominal wall, and later developed multiple problems including a gastrobronchial fistula. Computed tomography revealed a fistulous connection for which he had a combined procedure. Through a thoracolaparotomy approach, the left lower lobe and fistulous connection were removed along with the surrounding diaphragm and the associated fundus of the stomach. The diaphragm defect was repaired without mesh.
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Affiliation(s)
| | - Euan Dickson
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Ian W Colquhoun
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
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Abstract
This is a rare case of broncho-pleuropericardial fistula in a 12-year-old female who presented with fever, painful joint swelling, and pleural and pericardial effusion secondary to disseminated methicillin-sensitive Staphylococcus aureus infection. The pleural and pericardial effusion were drained, however, air leak was observed from both tubes and was synchronous with mechanical inspiration. A broncho-pleuropericardial fistula was suspected and confirmed with computed tomography. This case report demonstrated that disseminated S. aureus bacteremia could result in broncho-pleuropericardial fistula. The ability of disseminated staphylococcal infection to produce pnemopericardium should be added to the list of other complications associated with disseminated staphylococcal sepsis.
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Affiliation(s)
- Abeer A Arab
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
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Han WS, Kim K. Acute Postpneumonectomy Empyema with Bronchopleural Fistula Treated with Vacuum-assisted Closure Device. Korean J Thorac Cardiovasc Surg 2012; 45:260-2. [PMID: 22880174 PMCID: PMC3413834 DOI: 10.5090/kjtcs.2012.45.4.260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 11/28/2011] [Accepted: 12/01/2011] [Indexed: 11/16/2022]
Abstract
Postpneumonectomy empyema is a life-threatening complication, which is often related with a bronchopleural fistula. After surgical repair of fistula, sterilization of infected pleural cavity is important and usually carried out by long-term cyclic irrigation. We report a case in which vacuum-assisted closure device was successfully applied to sterilize the pleural cavity and obliterate bronchopleural fistula.
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Affiliation(s)
- Woo Sik Han
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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Jung GO, Park DE. Successful percutaneous management of bronchobiliary fistula after radiofrequency ablation of metastatic cholangiocarcinoma in a patient who has a postoperative stricture of hepaticojejunostomy site. Korean J Hepatobiliary Pancreat Surg 2012; 16:110-4. [PMID: 26388918 PMCID: PMC4575004 DOI: 10.14701/kjhbps.2012.16.3.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 07/30/2012] [Accepted: 08/02/2012] [Indexed: 11/17/2022]
Abstract
Bronchobiliary fistula (BBF) is a rare condition that is defined as an abnormal communication between the biliary system and bronchial tree. Furthermore, a BBF is an extremely rare complication of radiofrequency ablation (RFA). A 54 year-old man with a history of extrahepatic biliary cancer had been suffering with a benign stricture of hepaticojejunostomy site and was treated with RFA for metastatic cholangicarcinoma. In this report, we describe a patient with BBF complicated by an abscess which occurred after RFA. He was treated by placement of external drainage catheter into the liver abscess and percutaneous transhepatic biliary drainage (PTBD) into the right intrahepatic duct. After 6 weeks, a complete obliteration of the BBF was confirmed by a repeated follow-up of computed tomography scan and cholangiography through PTBD.
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Affiliation(s)
- Gum O Jung
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Dong Eun Park
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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