Late Postpneumonectomy Bronchopleural Fistula With Pleural Empyema

2022 ◽  
pp. 123-132
Author(s):  
Minervini Fabrizio ◽  
Scarci Marco ◽  
Sorino Claudio ◽  
Bertoglio Pietro
Keyword(s):  
Bronchopleural Fistula ◽  
Pleural Empyema

scholarly journals Transpleural Сontralateral Occlusion of the Left Main Bronchus Stump in a Patient with Bronchopleural Fistula and Chronic Pleural Empyema

2021 ◽  
Vol 14 (3) ◽  
pp. 216-220
Author(s):  
Alexey Nikolaevich Lednev ◽  
Alexey Aleksandrovich Pechetov ◽  
Sergey Sergeevich Karchakov ◽  
Maksim Aleksandrovich Makov
Keyword(s):  
Pleural Cavity ◽  
Main Bronchus ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Bronchial Tree ◽  
Bronchial Stump ◽  
Anatomical Features ◽  
Chronic Empyema ◽  
The Right ◽  
Methods Of Treatment

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and the pleural cavity, the most common complication of anatomical lung resection.BPF rarely closes spontaneously and almost always requires surgical or bronchoscopic interventions.The main methods of treatment are sanitation of the pleural cavity with the development of empyema and re-occlusion of the bronchial stump. The development of this complication in the postoperative period is accompanied by an increase in hospitalization time, a high risk of chronic pleural empyema, exacerbation of chronic diseases and death. The mortality rate ranges from 18 to 67%. Most often, BPF is manifested after removal of the right lung (8-13%), compared with the left side (1-5%), which is due to the anatomical features of the main bronchus.The presented clinical case describes a non-standard surgical approach in the treatment of bronchopleural fistula and chronic empyema of the residual pleural cavity in a young patient.

scholarly journals Photodynamic therapy in tuberculous pleural empyema

2021 ◽  
Vol 99 (5) ◽  
pp. 51-56
Author(s):  
S. D. Nikonov ◽  
M N. Smolentsev ◽  
D. V. Krasnov ◽  
D. А. Bredikhin ◽  
S. N. Belogorodtsev
Keyword(s):  
Photodynamic Therapy ◽  
Treatment Efficacy ◽  
Oxygen Radicals ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Complete Response ◽  
Antimicrobial Photodynamic Therapy ◽  
Outcome Predictor ◽  
Lethal Outcome ◽  
Light Density

as a lethal outcome predictor. To enhance treatment efficacy, TPE local sanitation method utilizing antimicrobial photodynamic therapy (PDT) has been developed. This technique is based on the generation of oxygen radicals by the interaction of photosensitizers and light quanta which inactivate Mycobacterium tuberculosis and pyogenic flora. To assess the sanitizing and antimicrobial efficacy of PDT, 96 procedures were performed in 16 patients (in 14 cases, TPE was complicated by bronchopleural fistula, in 10 cases it developed after surgical treatment of pulmonary tuberculosis). After intrapleural instillation of phthalocyanine aluminum 0.5 mg, all walls of the empyema cavity were irradiated by laser radiation with the wavelength of 662 nm and light density of 30-100 J/cm2. The response to PDT of tuberculous pleural empyema was reported in 93.75% of cases (n = 15), with complete response observed in 75% of cases (n = 12).

A Late Presentation of Postpneumonectomy Pleural Empyema and Bronchopleural Fistula

1998 ◽  
Vol 18 (6) ◽  
pp. 567-569
Author(s):  
Johan M. van der Klooster ◽  
Albert F. Grootendorst ◽  
Jan W. Brouwers
Keyword(s):  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Late Presentation

Omentoplasty in Treatment of Early Bronchopleural Fistulas after Pneumonectomy

2005 ◽  
Vol 13 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Dmitry Chichevatov ◽  
Alexander Gorshenev
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Postoperative Hospital Stay ◽  
The Other ◽  
Greater Omentum ◽  
Bronchial Stump ◽  
Primary Operation ◽  
Fistula Recurrence

This study was undertaken to assess the efficacy of omentoplasty in 12 cases of bronchopleural fistula after pneumonectomy. All fistulas formed within 16 days after the primary operation (median, 7 days). In 10 cases, omentoplasty was performed within 10 hours of diagnosis; the other 2 cases were treated at 28 and 31 hours. The greater omentum was mobilized through a laparotomy and secured tightly around the bronchial stump using original principles of fixation. After omentoplasty, dehiscence of the bronchial stump was observed in 5 (42%) patients, but owing to reinforcement with greater omentum, recurrence of the fistula was observed in only one case. In 3 patients, recurrence of pleural empyema did not lead to the return of the bronchopleural fistula. Hospital mortality was 8.3% (one patient). In patients without bronchopleural fistula recurrence, the median postoperative hospital stay was 31 days. Early omentoplasty for bronchopleural fistula after pneumonectomy is an effective procedure that eliminates purulent bronchopleural complications completely within the shortest possible period of time.

scholarly journals Video assisted thoracoscopic surgery in the management of acute fibrinopurulent empyema in paediatric patients

2020 ◽  
Vol 7 (6) ◽  
pp. 1847
Author(s):  
Arti S. Mitra ◽  
Nilesh G. Nagdeve ◽  
Simran R. Khatri ◽  
Unmed A. Chandak
Keyword(s):  
Hospital Stay ◽  
Thoracoscopic Surgery ◽  
Bronchopleural Fistula ◽  
Tertiary Care ◽  
Pleural Empyema ◽  
Care Hospital ◽  
Age Group ◽  
Video Assisted ◽  
The Mean ◽  
Video Assisted Thoracoscopic Surgery

Background: Empyema is the presence of pus in the pleural space that usually follows an episode of pneumonia in pediatric age group. The aim of this study was to assess the efficacy of management of acute fibrinopurulent stage of empyema by early video assisted thoracoscopic surgery (VATS) in paediatric patients.Methods: The study was carried out at a tertiary care hospital in India. It was a prospective interventional observational study. The study included 40 children between age group 0-12 years attending the surgery in-patient department referred for further management of parapneumonic effusions who had clinical and radiological evidence of empyema and thoracocentesis confirmed purulent exudate in pleural cavity, were subjected to early VATS after thorough pre-operative workup.Results: The mean age was 7.22 years. Average operative time was 135.5 minutes. The mean duration of hospital stay was 7.5 days. Few complications were bleeding, superficial wound infection, bronchopleural fistula, pneumothorax, recurrence of empyema and incomplete expansion of lung.Conclusions: VATS facilitates the management of fibrinopurulent and organised pyogenic pleural empyema with less post-operative discomfort and complications and reduced hospital stay. However larger sample size study is required to come to a definitive conclusion.

scholarly journals Epidemiology, etiology and prevention of postpneumonectomy pleural empyema

Folia Medica ◽  
2019 ◽  
Vol 61 (3) ◽  
pp. 352-357
Author(s):  
Danail B. Petrov ◽  
Dragan Subotic ◽  
Georgi S. Yankov ◽  
Dinko G. Valev ◽  
Evgeni V. Mekov
Keyword(s):  
Operative Mortality ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Bronchial Stump ◽  
Mesh Terms ◽  
Tube Removal ◽  
Life Threatening ◽  
Chest Tube Removal ◽  
Fistula Prevention

Background: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge. Materials and methods: A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention. Results: Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications. Conclusion: Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications.

scholarly journals PREOPERATIVE RADIOLOGIC EVALUATION OF BRONCHO-PLEURAL FISTULA AS PREPARATION FOR TRANSSTERNAL MAIN BRONCHIAL STUMP OCCLUSION

2018 ◽  
pp. 70-76
Author(s):  
A. A. Pechetov ◽  
A. Yu. Gritsiuta ◽  
P. I. Davydenko
Keyword(s):  
Recurrence Rate ◽  
Main Bronchus ◽  
Bronchopleural Fistula ◽  
Muscle Flap ◽  
Pleural Empyema ◽  
Control Group ◽  
Initial State ◽  
Bronchial Stump ◽  
Retrospective Assessment ◽  
Radiologic Evaluation

Objective:retrospective assessment of preoperative radiologic evaluation of patients with chronic pleural empyema and bronchopleural fistula after pneumonectomy and its influence on the choice of transsternal main bronchial stump occlusion as definitive surgical treatment.Methods.From April 2005 to December 2016 in A.V. Vishn evsky Institute of Surgery 25 patients with chronic pleural empyema (>12 weeks from the onset of the disease) and bronchopleural fistula (BPF) after pneumonectomy were treated. The main methods of preoperative diagnosis were fibrobronchoscopy and multispiral computed tomography. The results of treatment of BPF after pneumonectomy by transsternal bronchial occlusion as a method of choice were retrospectively analyzed.Results.Depending on the length of the bronchial stump and the diameter of the BPF, evaluated with CT, patients were divided into two groups. In 9 (36%) patients with bronchial stump length ≥20 mm and BPF diameter ≥3mm performed transsternal bronchial closure. In 16 patients (64%) with short (less than 20 mm) bronchial stump BPF was covered with muscle flap (87.5%) or omental flap transposition (12.5%) was done. Perioperative mortality rate was 2 (8 %) of 25 (95% CI: 2.2–24.9) cases due to ARDS and severe sepsis in muscleflap group. Recurrence rate was 2 (12.5%) of 16 (95% CI: 3.5–36) patients in control group vs no recurrence rate in basic group according to 18–110 months follow up.Conclusion. Radiologic methods are the gold standard in the diagnosis of pleural empyema with BPF. A differential approach based on the assessment of risk factors (the etiology of empyema, length of the stump of the main bronchus, diameter of bronchial fistula and initial state of residual pleural cavity) makes it possible to reduce morbidity and mortality in patients with BPF. 

scholarly journals Pneumonectomy due to bronchus carcinoma after pleural empyema

2002 ◽  
Vol 130 (5-6) ◽  
pp. 208-212
Author(s):  
Dragan Subotic ◽  
Dragan Mandaric ◽  
Nikola Atanasijadis ◽  
Ljiljana Andric
Keyword(s):  
Operative Procedure ◽  
Lung Resection ◽  
Bronchopleural Fistula ◽  
Preoperative Assessment ◽  
Pleural Empyema ◽  
Operative Morbidity ◽  
Mortality And Morbidity ◽  
Bronchus Carcinoma ◽  
Previous Infection ◽  
Postoperative Problems

Pneumonectomy is a lung resection that is associated with significantly higher operative mortality and morbidity than lobectomy. Beside classical causes of operative morbidity, such as respiratory and cardiovascular, the most important cause of postoperative complications is bronchopleural fistula. This complication occurs in 5 to 10 percents of patients with pneumonectomy, in some series up to 15 percents before introducing mechanical bronchial suture. The risk of the occurrence of this complication is increased in patients undergoing pneumonectomy after previous infection in the pleural space. Not so frequently, surgeons are faced with the necessity of performing pneumonectomy after pleural empyema as the first manifestation of the bronchus carcinoma. Over the last 5 years, in the the Institute of Lung Diseases, 4 patients underwent pneumonectomy after pleural empyema. The preoperative assessment, operative procedure and postoperative problems are the subject of this paper. Unlike the last three patients, in the first patient, pleural empyema was not recognized preoperatively. Based on the outcome of the treatment of the presented patients, we can conclude that pleural empyema, as the first manifestation of the bronchus carcinoma does not necessarily exclude surgical treatment. Such a statement is based on the fact that, even in these patients, it is possible to achieve postoperative course without significant morbidity and with a possibility to perform various forms of adjuvant therapy.

scholarly journals THE DIFFICULTIES IN DIAGNOSTICS AND TREATMENT TACTICS OF POSTRESECTION TUBERCULOUS PLEURAL EMPYEMA WITH BRONCHOPLEURAL FISTULA

2019 ◽  
Vol 9 (3) ◽  
pp. 209-214
Author(s):  
D.B. Giller ◽  
◽  
O.Sh. Kesaev ◽  
V.V. Koroev ◽  
M.V. Shilova ◽  
...  
Keyword(s):  
Bronchopleural Fistula ◽  
Pleural Empyema
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