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 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. 

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 The Amplatzer device and pedicle muscle flap transposition for the treatment of bronchopleural fistula with chronic empyema after lobectomy: two case reports

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yongyong Wu ◽  
Zhongliang He ◽  
Weihua Xu ◽  
Guoxing Chen ◽  
Zhijun Liu ◽  
...  
Keyword(s):  
Case Reports ◽  
Bronchopleural Fistula ◽  
Muscle Flap ◽  
Bronchial Tree ◽  
Chronic Empyema ◽  
Device Implantation ◽  
Amplatzer Device ◽  
Long Time ◽  
Effective Drainage ◽  
Muscle Flap Transposition

Abstract Background Bronchopleural fistula (BPF) refers to an abnormal channel between the pleural space and the bronchial tree. It is a potentially fatal postoperative complication after pulmonary resection and a complex challenge for thoracic surgeons because many patients with BPF ultimately develop refractory empyema, which is difficult to manage and has a major impact on quality of life and survival. Therefore, an operative intervention combined with conservative and endoscopic therapies may be required to control infection completely, to occlude BPF, and to obliterate the empyema cavity during treatment periods. Case presentation Two patients who suffered from BPF complicated with chronic empyema after lobectomy were treated in other hospitals for a long time and did not recover. In our department, we performed staged surgery and creatively combined an Amplatzer Septal Occluder (ASO) device (AGA Medical Corp, Golden Valley, MN, USA) with pedicled muscle flap transposition. First, open-window thoracostomy (OWT), or effective drainage, was performed according to the degree of contamination in the empyema cavity after the local infection was controlled. Second, Amplatzer device implantation and pedicled muscle flap transposition was performed at the same time, which achieved the purpose of obliterating the infection, closing the fistula, and tamponading the residual cavity. The patients recovered without complications and were discharged with short hospitalization stays. Conclusions We believe that the union of the Amplatzer device and pedicle muscle flap transposition seems to be a safe and effective treatment for BPF with chronic empyema and can shorten the length of the related hospital stay.

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 Metastatic atypical lung carcinoid treated with combined therapeutic modalities

2019 ◽  
Vol 147 (11-12) ◽  
pp. 769-772
Author(s):  
Nensi Lalic ◽  
Dragana Tegeltija ◽  
Ivan Kuhajda ◽  
Sanja Tomic ◽  
Ivica Lalic
Keyword(s):  
Carcinoid Tumor ◽  
Main Bronchus ◽  
Somatostatin Receptor ◽  
Treatment Strategies ◽  
Argon Plasma ◽  
Metastatic Potential ◽  
Bronchial Tree ◽  
Lung Tumors ◽  
The Right ◽  
Lung Carcinoid

Introduction. Lung carcinoids are considered a rare and uncommon group of lung tumors, making about 1% of all primary lung tumors. Atypical carcinoids are more aggressive than typical ones, with higher metastatic potential and worse prognosis and a 10-year survival rate of less than 60%. Case outline. In 2012, a 61-year-old male underwent the right lower lobectomy and the histopathological finding was an atypical lung carcinoid tumor. At the beginning of 2016, radiological and bronchoscopic progression of the disease was reported. Magnetic resonance imaging revealed enhanced nodular lesions compatible with liver metastases. The patient received endoluminal brachytherapy. Subsequently, the first line chemotherapy according to the cisplatin/etoposide (PE) protocol was applied. In August 2016, the somatostatin receptor scintigraphy (SRS) revealed secondary deposits with somatostatin receptor (SR) expression in the liver and lungs. The treatment with lanreotide injections was initiated. After five treatment courses, progression of the disease in the bronchial tree was verified and electro-cauterization and argon plasma cauterization of the tumor in the right main bronchus were performed. In September 2017, progression of the disease was verified again. The Oncology Board introduced the third line therapy with everolimus. Conclusion. The evidence supporting optimal treatment strategies for an atypical lung carcinoid tumor is lacking, but some recent publications indicate that multimodal treatment is associated with prolonged survival.

Intrapleural Foreign Body: Case Report

Respiration ◽  
2021 ◽  
pp. 1-4
Author(s):  
Alessandro Di Marco Berardino ◽  
Erino Angelo Rendina ◽  
Martina Bonifazi ◽  
Lina Zuccatosta ◽  
Letizia Lara Latini ◽  
...  
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Foreign Bodies ◽  
Pleural Cavity ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Pleural Space ◽  
Peripheral Airways ◽  
Pleural Surface ◽  
Body Case

The detection of foreign bodies in the pleural cavity is rare and mostly consequent to iatrogenic or traumatic events. The migration of an inhaled foreign body from the airways to the pleural space through a bronchopleural fistula is an exceptional event. We report a case of a pleural empyema consequent to an inhaled wooden skewer. CT scan and bronchoscopy were unable to identify the foreign body, due to its migration in the peripheral airways. The thin and pointed foreign body perforated the visceral pleural surface emerging in the pleural cavity.

scholarly journals FIRST EXPERIENCE OF CELL TECHNOLOGIES IN THORACIC SURGERY

2015 ◽  
Vol 7 (2) ◽  
pp. 7-13
Author(s):  
V I Egorov ◽  
P M Ionov ◽  
Y V Jurkiewicz ◽  
A B Smolyaninov ◽  
N K Besedina ◽  
...  
Keyword(s):  
Pleural Cavity ◽  
Bronchopleural Fistula ◽  
Isotonic Saline ◽  
Cellular Infiltration ◽  
Bronchial Stump ◽  
X Ray ◽  
Chest X Ray ◽  
Endobronchial Administration ◽  
Cellular Technology

Bronchoscopic bronchial fistulas closing tactics, despite the merits, is not sufficiently developed and is of limited use. One of the new ways of improving this area may consist of endobronchial bronchus occlusion of the fistula using cellular technology. The purpose of this study was to evaluate the effectiveness of endoscopic treatment of postoperative bronchial fistulas using cultured allogeneic fibroblasts. The study included 10 patients with bronchopleural fistula after pneumonectomy transferred for lung cancer and infectious and destructive process. The diameter of the defect bronchial stump averaged 5 mm. Endobronchial intervention consisted of submucosal injection of a suspension allofibroblastov human bronchial stump fistula zone. Introduction of cell suspension was carried out in an isotonic saline submucosal fistula bronchus area 2-5 points total volume of 1.5 ml. Concentration allofibroblastov - 3 x 10 6 cells / ml. State of bronchial stump and residual pleural cavity to monitor the implementation of bronchoscopy, chest X-ray, CT scan. It is shown that after endobronchial administration fibroblast suspension clearance fistula was not detected in 6 cases out of 10. obturation of the lumen of the bronchus occurs within 7-9 days after cell transplantation. In the remaining patients fistula persisted, requiring re-cellular infiltration. Follow-up bronchoscopy in two cases the fistula ended blindly and do not communicate with the pleural cavity, the diameter of the fistula opening in two patients decreased significantly, but not completely closed. Thus, bronhoendoskopic submucosal administration of a suspension allofibroblasts in projection bronchial fistula should be considered as a promising method of conservative treatment failure bronchial stump after radical operations on the lungs, allowing 60-80% of cases, to avoid re-open surgery.

Methods of main bronchus stump closure and incidence of bronchopleural fistula after pneumonectomies for lung cancer (a retrospective single center review)

2014 ◽  
Vol 20 (4) ◽  
pp. 183-189
Author(s):  
Saulius Cicėnas ◽  
Algirdas Jackevičius ◽  
Renatas Aškinis ◽  
Arnoldas Krasauskas ◽  
Nerijus Šileika ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Mediastinal Lymph Node ◽  
Main Bronchus ◽  
Bronchopleural Fistula ◽  
Bronchial Stump ◽  
Lung Cancer Patients ◽  
Lymph Node Sampling ◽  
Stump Closure

Background. Bronchopleural fistulas (BPFs) development after pneumo­nectomy remains a serious complication and is associated with high mortality rate. We evaluated incidence and risk factors, that influenced BPF rate after pneumonectomies for lung cancer patients treated at the Department of Thoracic Surgery and Oncology of the Institute of Oncology, Vilnius University, and compared different bronchial stump suturing techniques. Methods. It is a retrospective study. We reviewed 580 lung cancer patients who underwent pneumonectomies from January 1990 to January 2009. The average patient’s age was 60.1 ± 7.9 years (range from 34 to 76). Patients according to postoperative staging: stage IIA – 30 patients, IIB – 80, IIIA – 320, IIIB – 96, IV – 54. The most common tumor histology was planocellular carcinoma – 301, adenocarcinoma – 108, small-cell carcinoma – 76. Results. There were 327 (56.4%) right and 253 (43.6%) left pneumonectomies. Mediastinal lymph node dissection (LND) was performed to 387 (66.7%) and lymph node sampling (LNS) to 193  (33.3%) patients. The bronchial stump was covered in 285 (49.1%) patients. Bronchopleural fistula after pneumonectomy developed in 48 (8.3%) patients (bronchial dehiscence was confirmed by bronchoscopy), and 7 patients with BPF died (14.5%). BPF after right pneumonectomy occurred in 30 cases (9.5%) and after left pneumonectomy in 18 cases (7.1%), the difference was not statistically significant (p > 0.05). BPF after LND occurred in 38 cases (9.82%) and after LNS in 10 cases (5.18%), the dif­f erence was statistically significant (p 

scholarly journals Isсhemic change in bronchus stump after lung cancer resection

2020 ◽  
Vol 179 (3) ◽  
pp. 33-39
Author(s):  
S. A. Plaksin ◽  
L. I. Farshatova ◽  
A. L. Lisichkin
Keyword(s):  
Main Bronchus ◽  
Lung Resection ◽  
Bronchopleural Fistula ◽  
Lower Lobe ◽  
Lobe Bronchus ◽  
Doppler Flowmetry ◽  
Bronchial Wall ◽  
Risk Patients ◽  
The Right ◽  
Right Lower Lobectomy

The OBJECTIVE of the study was to assess the changes in blood supply of the bronchus stump following lung resection with lymph node dissection.METHODS AND MATERIALS. Bronchial microcirculation was studied in 8 patients during pneumonectomy of the wall of the main bronchus using laser Doppler flowmetry method. In this paper, we present our observations of postoperative necrotic ischemic bronchitis after lobectomy with associated formation of bronchopleural fistula of the main bronchus and the failure of the stump of the lobular bronchus.RESULTS. Mobilization of the bronchus decreased microcirculation rate to (3.3±0.3) conventional units (c. u.), or to 74.5 %; lymphatic dissection further reduced microcirculation rate to (2.6±0.2) c. u., or to 60.2 %. An additional twisted suture was found to worsen ischemia. The normalized value of the amplitude decreased during the second minute of the dissection of the bronchus, indicating hypoxia. A 61-year-old patient with diabetes showed damage to the wall of the main bronchus 0.6 cm in size 7 days after undergoing the right lower lobectomy with lymphatic dissection. On the 19th day after the same procedure, the same patient developed an insolvency of the stump of the lower lobe bronchus, which was classified as a manifestation of ischemia. Postoperative ischemic bronchitis can occur in a true ischemic or an ulcerative necrotic form, and it can be diagnosed using a macroscopic picture in the context of fibrobronchoscopy. It occurs in (2.5–3.2) % of patients who underwent lung resections for cancer with lymphatic dissection.CONCLUSION. Ischemia of the bronchial wall during its mobilization plays a significant role in the etiology of bronchopleural fistula. Lymphatic dissection worsens microcirculation of the bronchial wall. Ischemic necrotic bronchitis can lead to formation of the bronchopleural fistula outside of the stump. High-risk patients require additional coverage of the bronchus stump with muscle or fat tissue.

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