A bronchopleural fistula bpf is a cavity that develops between the bronchial tree and the pleural space. The aim of the study was to assess the feasibility, efficacy and safety of the use of a conical selfexpandable stent for the treatment of postpneumonectomy bronchopleural fistula ppbpf. While most heal spontaneously, a persistent bronchopleural fistula may seriously impair the ability to ventilate a patient secondary to loss of tidal volume through the fistula. The low incidence of tuberculosis added to the development of technical and surgical thoracic equipment has greatly decreased its incidence. This grouping is important in management of patient treatment. After multiple reports demonstrating excellent results and improved healing of the bronchial stump in cases of pneumonectomy performed with standard reusable parallel firing stapling devices, there has been an isolated report from europe of increased incidence of bronchopleural fistulas with the use of the modified reusable hinged stapling device. The low incidence of tuberculosis added to the development of technical and surgical thoracic equipment has greatly decreased its. Pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumopericardium, and other forms of extraalveolar air are referred to as barotrauma. Jan 14, 2019 a bronchopleural fistula bpf can lead to empyema and death after pulmonary resection. The overall incidence of postoperative bpf after lung cancer surgery is reportedly 1. Highfrequency oscillatory ventilation in an infant with. The majority of patients present within 3 months postoperatively, most of whom do so within the.
Thoracoplasty for postpneumonectomy empyema associated with. Pdf closure of bronchopleural fistula with angioseal. Bronchopleural fistulae most commonly arise as a postoperative complication, but can occur in other clinical settings, such as inflammatory disease of the lung, blunt chest trauma, and barotrauma. Bronchopleural fistula an overview sciencedirect topics. Conservative treatment of postlobectomy bronchopleural. Three patients had bpf after the right pneumonectomy, six patients. One of the most morbid postoperative complications after a lobectomy or a pneumonectomy is a bronchopleural fistula bpf. Placement of endobronchial valves for bronchopleural fistula bpf is not always straightforward. Endobronchial control of bronchopleural fistulae chest. Most published papers deal with endoscopic and surgical treatment. Postlobectomy bronchopleural fistula is a rare complication of lung resection surgery, and proper management is essential for its successful resolution.
Bronchopleural fistula after pneumonectomy for lung cancer. The possibility of curing this complication using a conservative treatment is extremely poor. We describe a case of late bronchopleural fistula after right extrapleural pneumonectomy for malignant mesothelioma. Consideration was given to the use of a muscle flap or omental flap closure of the pleural space. Diagnosis and localisation of bpf is sometimes difficult and may require multiple imaging and bronchoscopies. Because these patients are usually very catabolic, assessment of requirements and nutritional therapy is an essential part of their management. Bronchopleural fistula is an anomalous connection between the bronchial and pleural cavity.
We successfully treated 2 patients by insertion of coils and cyanoacrylate glue into and adjacent to the fistula of a. Management of postpneumonectomy empyema and bronchopleural fistula. This is seen in the patients who are receiving mechanical ventilation or have bronchopleural fistula. Although surgery remains the cornerstone of care, no standard therapeutic.
Bronchoscopy in the management of bronchopleural fistula. It is associated with high mortality, morbidity and prolonged hospital stay necessitating further thoracotomy. The patient arrives at the tertiary hospital and admitted to the icu, a left sided bronchopleural fistula was subsequently identified on bronchoscopy and was repaired endoscopically. We describe a technique using intramucosal injection of glue to close a bronchopleural fistula via bronchoscopy. Bronchopleural fistula and the role of contemporary imaging. Aug 06, 20 bronchopleural fistula is a communication in the form of a sinus tract between the pleural space and the bronchial tree or a communication between the lung parenchyma and the pleural space. Brochopleural fistula following lung resection is a therapeuric challenge for thoracic surgeons. Treatment of bronchopleural fistula after pneumonectomy. A diagnosis of postpneumonectomy empyema with bronchopleural fistula was made.
Initial treatment is conservative, with antibiotics and tube drainage, to allow healing of the fistula. Postpneumonectomy bronchopleural fistula is a serious complication with high morbidity and mortality l61. Twelve patients with postpulmonectomy bpf were enrolled in this study at the liaoning tumor hospital between february 2009 and march 2012. It a serious complication often caused by lung cancer surgery. Surgical treatment of the fistula is usually impossible because of the association with empyema 3. Pdf bronchopleural fistula or alveolopleural fistula. Some fistulas are created surgically for diagnostic or therapeutic purposes.
Diagnosis and management bronchopleural fistula pralay sarkar,1 twinkle chandak,2 rakesh shah3 and arunabh talwar2 department of medicine 1, and division of pulmonary, critical care and sleep medicine 2, north shorelong island jewish health system and department of radiology 3, north shore university hospital, usa abstract. Bronchopleural fistula following pneumonectomy is a serious and frightening complication in chest surgery with a high mortality rate. Pdf diagnosis and management bronchopleural fistula. Management of bronchopleural fistula complicating therapy with positive end expiratory pressure peep.
Treatment of persistent bronchopleural fistula with a manually. Standard treatment for persistent bronchopleural fistulas involves thoracotomy with primary closure and transposition of a vascularized muscle flap to the bronchial leak site. We think that almost all of the reports in their reference list. Postoperative bronchopleural fistula bpf and empyema are not uncommon complications after lung cancer surgery. We evaluated principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula bpf, focusing on openwindow thoracostomy owt. Bronchoscopic management of bronchopleural fistula. A bronchopleural fistula is an abnormal passageway a sinus tract that develops between the large airways in the lungs the bronchi and the space between the membranes that line the lungs the pleural cavity. Surgical approaches for bronchopleural fistula bronchopleural fistula bpf is defined as a direct communication between the bronchus and the pleural space. Treatment strategies for bronchopleural fistula sciencedirect. Here are some important points to be to be remembered while writing about bronchopleural fistula. Dehiscence of the bronchial stump, particularly following pneumonectomy, is one of the most serious complications in lung surgery. The majority of patients present within 3 months postoperatively, most of whom do so within the first 12 days after surgery.
The term bronchopleural fistula bpf refers to a leakage of inspired air from the airways into the pleural space for more than 24 hours. The development of bronchopleural fistula after pulmonary resection is a wellknown complication associated with a high mortality rate. Bronchopleural fistulas are communications between the bronchial tree and the pleural space. Conservative management of postoperative bronchopleural fistulas. Pneumonectomy is a formidable operation with considerable morbidity and definite mortality of 57%. Takehome points for management of bronchopleural fistula. Bronchopleural fistula is frequently a manifestation of underlying severe lung disease. Communication between bronchial tree and pleural space high morbidity and mortality prolonged hospital stay no standard treatment guidelines or consensus aetiology. It is unusual and occurs often secondary to resection of the lung for malignancies, although there are several other known etiologies for this condition. Various approaches to this problem have been tried. Dumon stent is an acceptable option for the treatment of postoperative bronchopleural fistulas.
A bronchopleural fistula is a direct connection between the bronchus and atmosphere by way of the pleural space and tube thoracostomy. Conservative management of postoperative bronchopleural. Bronchopleural fistula bpf with or without a postpneumonectomy empyema ppe is one of the most dreaded events that can affect the postoperative course following pneumonectomy. It is applicable both in empyema that occurred after pneumonectomy or that developed in a residual pleural space, regardless of the size of the bronchopleural fistula. Bronchopleural fistula is a potentially fatal condition that may result after a variety of clinical conditions, most commonly after pulmonary resection. A bronchopleural fistula is a persistent leak from the lung into the pleural space, identified by either intermittent during inspiration or continuous chest tube air leak. A bronchopleural fistula bpf can lead to empyema and death after pulmonary resection. This is a most common postoperative complication of lung surgeries and also one of the recently asked questions in dnb respiratory diseases theory exams. A minor leakage from a bpf has been reported to be successfully closed endobronchially, although thoracoplasty is usually needed. Dr chiranjib bhattacharyya associate professor dept. Although it is not uncommon to observe minor air leaks beyond 24 hours in the postpneumonectomy setting, most of them resolve spontaneously. Successful management of chronic postoperative bronchopleural fistula remains a challenge for thoracic surgeons.
Bronchopleural fistulas an overview of the problem with special focus on endoscopic management manuel lois, md, fccp. Either surgical or bronchoscopic repair is required to definitively correct these lesions, though a small number may resolve spontaneously with optimal ventilatory care and other options. Fortytwo patients 33 referred from other institutions were treated for major postoperative bronchopleural fistula since 1978. The management of persistent bronchopleural fistula is one of the most complex challenges encountered by the chest physician. Bronchopleural fistula bpf is a sinus tract between the mainstem, lobar or. Bronchoscopic attempts to repair it were unsuccessful. The bpf was successfully occluded without complications, and there was no stent migration or any other problem seen at the 1year followup.
Bronchopleural fistula was suspected by clinical signs and. Bronchopleural fistula radiology reference article. A simple guide to the steps for an uncomplicated procedure does not encompass pitfalls that need to be understood and overcome to maximize the efficacy of this modality. Bronchopleural fistula essentials of mechanical ventilation. Pdf the diagnosis and management of bronchopleural fistula bpf remain a major therapeutic challenge for clinicians. Nonsmall cell lung canceraccounted for 451 cases and 20 cases were small cell cancer.
Reconstructive surgery for bronchopleural fistula and. Bronchopleural fistula bpf is a pathological communication between the bronchial tree and pleural space. Bronchopleural definition of bronchopleural by medical. A bpf is often a fatal complication of lung surgery postoperatively. The anaesthetic management of operations for bronchopleural fistula in twentytwo patients is discussed. Risk factor of bronchopleural fistula after general thoracic surgery. Bpfs can have devastating consequences, with mortality of 25% to 71% and prolonged hospital stays involving multiple procedures for survivors. Bronchopleural fistula management critcases em cases. The diagnosis and management of bronchopleural fistula bpf remain a major therapeutic challenge for clinicians. It is a severe complication after pulmonary resection and carries a high mortality rate, ranging from 25% to 67%. Bronchopleural fistulas were located in the right main.
Two patients with postpneumonectomy bronchopleural fistula were treated successfully by using a pedicle of the greater omentum. What is standard treatment for bronchopleural fistulas. Bronchopleural fistula treated with a siliconecovered. Therapeutic options range from extensive surgical procedures, including. Bronchopleural fistula after pneumonectomy adult chest. Therefore, many other methods of treatment have been. It is associated with significant morbidity and mortality. Treatment of bronchopleural fistula with carbolic acid. Bronchopleural fistula definition of bronchopleural fistula. Healing of bronchopleural fistula using a modified dumon. To investigate the efficacy of carbolic acid treatment of bronchopleural fistula bpf using bronchofiberscope bfs in postpulmonectomy patients. Treatment of bronchopleural fistula after pneumonectomy by.
Bpf is an important cause of morbidity and mortality and its management depends on various factors like size of fistula, respiratory. In this critically ill infant with necrotizing pneumonia and bronchopleural fistula, we selected a ph lower limit of 7. Bronchopleural and alveolopleural fistulae from surgical and nonsurgical causes present unique. In highrisk surgical patients, endoscopic procedures may serve as a temporary bridge until the patients clinical. Ct is considered the imaging technique of choice for visualizing and characterizing bronchopleural fistulae 2. Management of post pneumonectomy bronchopleural fistula. This procedure is indicated in patients who have empyema, with or without bronchopleural fistula that did not respond to vigorous therapy with antibiotics and tube drainage. It is defined as an abnormal communication between the bronchial tree and the pleural space. Localization of the fistula and size may indicate potential benefits of surgical vs endoscopic procedures. Thoracoscopic surgery using omental flap for bronchopleural. Treatment consisted of oriented pleural drainage, adequate antibiotic therapy, and endoscopic closure of the fistula with local application of silver nitrate through. Common causes of bronchopleural fistula bpf are lung resection, thoracic surgery, thoracic trauma, pulmonary kochs, rupture of lung abscess and rupture of emphysematous bullae, as was seen in this case. The technique and the results of this method are described. Bronchopleural fistula the western journal of emergency.
Bronchopleural fistula bpf after pneumonectomy is a lifethreateningcomplication. We consider that the standard treatment for bronchopleural fistulas is a thoracotomy with primary closure and coverage with a vascularized muscle flap of the bronchial leak site. Bronchopleural fistula was suspected by clinical signs and confirmed by endoscopic visualization. Below we describe a case of a patient affected by left pleural empyema due to a postpneumonectomy bronchopleural fistula. Pdf bronchoscopic management of bronchopleural fistula. Over a period of 14 years january 1980 to november 1993,471 pneumonectomies were performed byone surgical team using a uniformsuture technique for primary lung cancer. Bronchopleural fistula after pneumonectomy remains a challenge after lung cancer surgery. We present a case of postpneumonectomy bpf successfully managed with a siliconecovered bronchial occlusion stent. The numerous therapeutic methods to achieve definite closure of the fistula indicate the difficulty and complexity of the. The use of a modified y dumon stent associated with glue apposition on the. A pathological connection between the main stem, lobar, or segmental bronchus and the pleural space is termed bronchopleural fistula bpf. Pdf treatment strategies for bronchopleural fistula. A case of successful thoracoscopic bpf closure using an omental flap in a 74yearold man with emphysema who developed a bpf.
Bronchopleural fistula definition of bronchopleural. The diagnosis and identification of bpf may be challenging, often requiring repeat imaging and invasive tests, including bronchoscopy, thoracoscopic exploration, or even open exploration. Endoscopic gluing of bronchopleural fistula the annals of. Closure of bronchopleural fistula by interventional. This air leak can be due to either alveolopleural fistula apf or bronchopleural fistula bpf. A completion sleeve bilobectomy for nonstump postlobectomy bronchopleural fistula. A bronchopleural fistula is caused by a connection between the pleural space and the consolidated lung. This report describes a case of a postoperative bronchopleural fistula successfully managed with a modified dumon stent. Surgical interventions for the bronchopleural fistula with empyema were subsequently avoided. He is eventually transferred to the trauma ward and recovers neurologically intact.
A bronchopleural fistula is a connection from the bronchial tree to the pleural space. Bronchopleural fistula bpf, one of the potentially fatal complications after pulmonary resection, remains a therapeutic challenge. The usual bronchopleural fistula leading to spontaneous pneumothorax, subsequent to chest trauma, associated with large raw surfaces following pulmonary resections, or seen with ventilator support, 1 x 1 zimmerman, j. Bronchopleural fistulas bpfs carry significant morbidity. The bpf was successfully occluded without complications, and there was no stent migration or any other problem seen at the 1. A case of successful thoracoscopic bpf closure using an omental flap in a 74yearold man with emphysema who developed a bpf after right lower lobectomy for lung cancer is. Author links open overlay panel claude deschamps mark s. Surgical approaches for bronchopleural fistula agnol. It a serious complication often caused by lung cancer surgery, 1. Intercostal muscle flap for repair of bronchopleural fistula. It is a source of morbidity and mortality in patients, particularly those who undergo lung resection. It is difficult to diagnose and is associated with a high incidence of mortality. Here are some important points to be to be remembered.
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