TREATMENT OF BRONCHIAL FISTULA ASSOCIATED WITH NON-SPECIFIC CHRONIC PLEURAL EMPYEMA: Review

The treatment of non-specific chronic pleural empyema with bronchial fistulae remains one of the most relevant issues in thoracic surgery. The question about the treatment phasing of bronchial fistulae associated with chronic pleural empyema is yet to be answered. Is it reasonable to seal a bronchial fistula before or after the sanitation and obliteration of the residual pleural cavity? The choice of bronchial fistula sealing technique is also a relevant issue because, in spite of the multitude of techniques, there is still no single doctrine. The terms of traditional and minimally invasive techniques aimed at bronchial fistula sealing and pleural cavity obliteration are not defined, either. This article summarises the opinions of leading authors presented in the literature concerning the solution of this complex, life-threatening problem.

Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review

Background The development of esophago-bronchial fistula after esophagectomy and reconstruction using a posterior mediastinal gastric tube remains a rare complication associated with a high rate of mortality. Case presentation A 63-year-old man with esophageal cancer underwent a thoracoscopic esophagectomy with two-field lymph node dissection and reconstruction via a gastric tube through the posterior mediastinal route. Postoperatively, the patient developed extensive pyothorax in the right lung due to port site bleeding and hematoma infection. Four months after surgery, he developed an esophago-left bronchial fistula due to ischemia of the cervical esophagus and severe reflux esophagitis at the site of the anastomosis. Because of respiratory failure due to the esophago-bronchial fistula and the history of extensive right pyothorax, right thoracotomy and left one-lung ventilation were thought to be impossible, so we decided to perform the surgery in three-step systematically. First, we inserted a decompression catheter and feeding tube into the gastric tube as a gastrostomy and expected neovascularization to develop from the wall of the gastric tube through the anastomosis after this procedure. Second, 14 months after esophagectomy, we constructed an esophagostomy after confirming blood flow in the distal side of the cervical esophagus via gastric tube using intraoperative indocyanine green-guided blood flow evaluation. In the final step, we closed the esophagostomy and performed a cervical esophago-jejunal anastomosis to restore esophageal continuity using a pedicle jejunum in a Roux-en-Y anastomosis via a subcutaneous route. Conclusion This three-step operation can be an effective procedure for patients with esophago-left bronchial fistula after esophagectomy, especially those with respiratory failure and difficulty in undergoing right thoracotomy with left one-lung ventilation.

Surgical Resection of Gastro-Pleural-Bronchial Fistula after Prolonged Endoscopic Treatments

Sleeve gastrectomy is the most commonly performed bariatric surgery in the United States. While complication rates are typically low, some studies have reported leaks in up to 2.4-5.3% of cases. Here, we examine such a case with subsequent failure of numerous endoscopic interventions ultimately necessitating formal resection of a gastro-Pleural-bronchial fistula.

Intrathoracic transposition of the omentum

Complex chest and lung infections with bronchial fistula are life-threatening situations with a mortality rate of up to 20%. If medical treatment fails, these patients require aggressive procedures to heal. Transposition of the omentum is a valuable, nonstandard option in these complex cases with aggressive infection involving the pleural space, with or without a bronchial fistula, when medical treatment is unsuccessful. We present a 29-year-old female patient diagnosed with primary immunodeficiency and invasive fungal infection with involvement of the left upper lobe and mediastinal and vertebral bodies treated with a lobectomy and intrathoracic transposition of the omentum.

Chemotherapy taste and bronchospasm: a consequence of a fistula between the superior vena cava and the right main bronchi

ABSTRACT A 56-year-old female patient with upper lobe neoplasia of the right lung and superior vena cava syndrome. The patient complained about the taste of the medications during the chemotherapy sessions. Interventional radiology diagnosed cava-bronchial fistula when it injected contrast into the inferior and superior vena cava.

An Infectious Cause of Esophagobronchial Fistula

An infected cause of esophagobronchial fistula between left bronchus and esophagus is mentioned who is a 32 year old male with a history of smoking and I/V drug abuse. The scientific reasons for suspecting an esophagogastric-bronchial fistula in an adult are discussed, as well as a description of the different etiologies of this condition. Intra thoracic malignancy, injuries, and infections are the most frequent causes of esophageal-bronchial fistula. These fistulas are caused by the rupturing of caseous peribronchial lymph nodes into adjacent structures such as the esophagus and bronchi. It's difficult to determine what the right course of action is. Such cases are surgically treated, while others can only be treated conservatively. Diagnosing bronchoesophageal fisula is usually challenging and often delayed, since there have not been many cases found. Any patient who presents with cough after deglutition should be suspected of having an esophagobronchial fistula, and tubercular origin should also be considered, particularly in an endemic region, since early diagnosis and treatment with anti-tubercular therapy typically results in resolution.

Intrabronchial migration of hemostatic agent through a bronchial fistula after lung transplantation: a case report

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.