Omentoplasty and Thoracoplasty for treating postpneumonectomy bronchopleural fistula in a patient previously submitted to aortic prosthesis implantation
© Nosotti et al; licensee BioMed Central Ltd. 2009
Received: 07 April 2009
Accepted: 24 July 2009
Published: 24 July 2009
Bronchopleural fistula following pneumonectomy is a serious and frightening complication in chest surgery with a high mortality rate. The possibility of curing this complication using a conservative treatment is extremely poor. Below we describe a case of a patient affected by left pleural empyema due to a postpneumonectomy bronchopleural fistula. The patient had previously undergone an aortic prosthesis implantation. He was successfully treated using omental pedicle in order to cover the bronchial stump, to fill the pleural space and to protect the aortic prosthesis. He also underwent thoracoplasty to collapse the residual pleural space. The postoperative course was uneventful. During the follow-up, after thirty months, the patient was asymptomatic, and no recurrence of the fistula was present.
Bronchopleural fistula (BPF) is a serious and frightening complication of pulmonary surgery with a high mortality rate . Different methods have been used to close the fistula; from conservative treatment such as bronchial gluing or stent placement , to surgical management [2, 3].
We report a case of postpneumonectomy BPF successfully treated using omental pedicle and thoracoplasty in a patient with previously aortic prosthesis implantation.
Drainage of the infected pleural space, antibiotics to treat infection, and accurate clearance of secretions from the remaining lung should be the initial treatment modality in Stage 1 disease [4, 5]. Once the infection is under control, several surgical techniques can be considered in order to cure BPF ranging from omentoplasty, pedicled pericardial fat or pleural flap, myoplasty, thoracoplasty . In our patient we considered the omentoplasty to cover the bronchial stump and to protect the aortic prosthesis, and thoracoplasty to collapse the left pleural space and to control the underlying inflammatory process.
In complex subset we believe that omentoplasty is a reliable approach when attempting to close bronchopleural fistula as also reported by other authors [2, 3], since the omentum has the ability to function in the established infected area demonstrated by its natural role in the abdomen . To our knowledge, the case reported is the first in English literature because of the presence of a non-covered aortic prosthesis in an infected pleural cavity, with a very high risk of infection and rupture of the prosthesis.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Ferraroli GM, Testori A, Cioffi U, De Simone M, Alloisio M, Galliera M, Ciulla MM, Ravasi G: Healing of Bronchopleural fistula using a modified Dumon stent: a case report. J Cardiothorac Surg. 2006, 1: 16-10.1186/1749-8090-1-16.View ArticlePubMedPubMed CentralGoogle Scholar
- Martini G, Widmann J, Perkmann J, Steger K: Treatment of bronchopleural fistula after pneumonectomy by using an omental pedicle. Chest. 1994, 105 (3): 957-9. 10.1378/chest.105.3.957.View ArticlePubMedGoogle Scholar
- Yokomise H, Takahashi Y, Inui K, Yagi K, Mizuno H, Aoki M, Wada H, Hitomi S: Omentoplasty for postpneumonectomy bronchopleural fistulas. Eur J Cardiothorac Surg. 1994, 8 (3): 122-4. 10.1016/1010-7940(94)90166-X.View ArticlePubMedGoogle Scholar
- Molnar TF: Current surgical treatment of thoracic empyema in adults. Er J Cardiothorac Surg. 2007, 32: 422-30. 10.1016/j.ejcts.2007.05.028.View ArticleGoogle Scholar
- Puskas JD, Mathisen DJ, Grillo HC, Wain JC, Wright CD, Moncure AC: Treatment strategies for bronchopleural fistula. J Thorac Cardiovasc Surg. 1995, 109: 989-996. 10.1016/S0022-5223(95)70325-X.View ArticlePubMedGoogle Scholar
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