We describe a case of late bronchopleural fistula after right extrapleural pneumonectomy for malignant mesothelioma. A bronchopleural fistula is a severe complication of lung cancer surgery with mortality death rates varying from 10 to 27 percent depending on the study. Bronchopleural fistula essentials of mechanical ventilation. Full text full text is available as a scanned copy of the original print version. Pdf bronchoscopic management of bronchopleural fistula. The technique and the results of this method are described. By far, the postoperative complication of pulmonary resection is the most common cause, followed by lung necrosis complicating infection, persistent spontaneous pneumothorax. Anastomotic leaks medical seqno 3620 surgical segnos 3350, 3360, 3370, 3380. Fortytwo patients 33 referred from other institutions were treated for major postoperative bronchopleural fistula since 1978. Bronchopleural fistula after pneumonectomy adult chest.
Efficacy of bronchoscopic closure of a bronchopleural fistula with. Treatment strategies for bronchopleural fistula the journal. Bronchopleural fistula empyema middle lobectomy for torsion conduit necrosisfailure following esophageal surgery other nb. Brochopleural fistula following lung resection is a therapeuric challenge for thoracic surgeons. Apleural space orchestwall infection with agasproducing organism, although rare,canresult inahydropneumothorax, ascanaccidental administration ofairinto thepleural space orchest wall. Bronchopleural fistula bpf remains a rare but fatal complication of thoracic surgery.
The bronchopleural fistula causes a pyopneumothorax i. If the fistula communicates with the surface of the chest, it is a bronchopleural cutaneous fistula. Air leaks, alveolopleural or bronchopleural fistulas, either spontaneous, iatrogenic, or postsurgical, can be difficult to treat, and if prolonged in spite of proper chest tube thoracostomy they may require surgical or chemical pleurodesis with variable success. Fortunately for the patient the fistula likely sealed itself with just the chest tube in place which was removed one week later. Treatment strategies for bronchopleural fistula the. Successful management of a fistula is combined with treatment of the. The development of a bronchopleural fistula bpf after lung resection is a lifethreatening complication, and thoracic surgeons should always consider the risk of bpf in their patients. 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. Pneumonectomy is a formidable operation with considerable morbidity and definite mortality of 57%. Conservative management of empyemacomplicated post. Use of an amplatzer device for endoscopic closure of a large. Some fistulas are created surgically for diagnostic or therapeutic purposes.
Communication between the airways and the pleural space substantially increases the risk of. Medical management and therapy of bronchopleural fistulas. Treatment of bronchopleural fistula with carbolic acid. Bronchopleural fistula bpf is a sinus tract between the main stem, lobar, or segmental. Management of bronchopleural fistula after lobectomy. Here are some important points to be to be remembered while writing about bronchopleural fistula. Bronchopleural fistula an overview sciencedirect topics. A bronchopleural fistula bpf is a communication between the pleural space and the bronchial tree. In years past, this complica tion was encountered far more frequently. The acute presentation of a bpf is frequently heralded by the sudden expectoration of potentially infected material from the pleural space due to airway communication. Bpf or a pulmonary fistula was present in 11 patients at the time of reconstruction. Diagnosis and management bronchopleural fistula medind. Oneweek recovery from bronchopleural fistula by combined techniques bronchopleural fistula bpf is an uncommon, but severe complication of pulmonary resection surgery 1. Surgical treatment of the fistula is usually impossible because of the association with empyema 3.
During this period 3150 pulmonary resections were performed for various conditions and 86 fistulas occurred, an incidence of 27per cent. Therapeutic options range from extensive surgical procedures, including. Bronchopleural definition of bronchopleural by the free. Oneweek recovery from bronchopleural fistula by combined. Results of surgical closure of bronchopleural fistula with. Healing of bronchopleural fistula using a modified dumon.
Oct 21, 20 a bpf is often a fatal complication of lung surgery postoperatively. Management of acute bronchopleural fistula adult chest. It is a severe complication after pulmonary resection and carries a high mortality rate, ranging from 25% to 67%. Bronchoscopic closure of bronchopleural fistula using gelfoam. Surgical approaches for bronchopleural fistula agnol shanghai. Bronchopleural fistula definition of bronchopleural. Bronchoscopic attempts to repair it were unsuccessful. And the mortality rates associated with bpf are alarmingly high and ranges between 7. A bronchopleural fistula bpf is a fistula between the pleural space and the lung. Communication between bronchial tree and pleural space high morbidity and mortality prolonged hospital stay no standard treatment guidelines or consensus aetiology.
The diagnosis and management of bronchopleural fistula bpf remain. Our patient suffered from a large bronchopleural fistula, following right lower lobectomy and was considered inoperable. A bronchopleural fistula is a connection from the bronchial tree to the pleural space. Bronchopleural fistula definition of bronchopleural fistula. Surgical approaches for bronchopleural fistula agnol. Bpf most commonly occur after large thoracic surgeries such as pneumonectomy but can. Bpf can be classified as central, which are fistulous connections between the trachea or a lobar bronchus and the pleural space, or peripheral, which are fistulous connections between the distal airway segmental bronchi or lung parenchyma and the pleural.
Pdf diagnosis and management bronchopleural fistula. The use of a modified y dumon stent associated with glue apposition on the bronchial stump allowed us to close the fistula. Conservative management of postoperative bronchopleural fistulas. Of these, a free fascial patch graft combined with a free soft tissue flap was used to close the fistula in 6 cases. Bronchopleural fistula bpf is a relatively infrequent but potentially fatal complication of pulmonary resection. Highfrequency oscillatory ventilation in an infant with. The feeding tube was taken out and a large bore chest tube was placed. Bpfs can have devastating consequences, with mortality of 25% to 71% and prolonged hospital stays involving multiple procedures for survivors. This grouping is important in management of patient treatment.
A bronchopleural fistula is a direct connection between the bronchus and atmosphere by way of the pleural space and tube thoracostomy. Surgical approaches for bronchopleural fistula bronchopleural fistula bpf is defined as a direct communication between the bronchus and the pleural space. Management of post pneumonectomy bronchopleural fistula. The society of thoracic surgeons general thoracic surgery. Localization of the fistula and size may indicate potential benefits of surgical vs endoscopic procedures. Factors associated with bronchopleural fistula included right pneumonectomy n 23, left pneumonectomy n 8, long bronchial stump n 16, pneumonia. Watanabe s, shimokawa s, yotsumoto g, sakasegawa k. Although rare, bpfs represent a challenging management problem and. Papadakos pj and lachmann b eds mechanical ventilation. Endobronchial treatment of bronchopleural fistulas by. Bpf can be divided into peripheral or central, based on the location of the leakage, and bpf occurs in about 1. However, the morbidity associated with this complication is still significant. 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. 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.
Bronchopleural fistulas may present acutely or subacutely and are influenced by the presence of pleural space infection. It can develop following pneumonectomy, post traumatically, or with certain types of infection. Elsevier, philadelphia, pennsylvania usa, pp 337354 6. The majority of patients present within 3 months postoperatively, most of whom do so within the.
Links to pubmed are also available for selected references. This novel treatment is suitable only for patients with large bpf and long tract communicating between the bronchial system and the pleural cavity. Bronchopleural fistula bpf is defined as a direct communication between the bronchus and the pleural space. Bronchopleural fistula bpf is a rare condition which presents a diagnostic and therapeutic challenge to physicians and is often fatal 1. It a serious complication often caused by lung cancer surgery. Although rare, bpfs represent a challenging management problem and are associated with high. In the other 5 cases, primary fistula closure or direct coverage of the fistula with a transferred flap was performed. In the absence of any other options, a novel endoscopic technique, using an amplatzer septal occluder device, was successfully applied resulting in the closure of the bronchopleural fistula. 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, et al modified dumon stent for the treatment of a bronchopleural fistula after pneumonectomy. The treatment of bpf includes control of infection, pleural space drainage, surgical interventions and bronchoscopic interventions. Successful management of chronic postoperative bronchopleural fistula remains a challenge for thoracic surgeons. Bronchopleural fistula is an open and aberrant communication between some portion of the bronchial tree and the pleural space, through which inspired gas enters the pleural space.
The aim of this study was to develop and validate a predictive model of bpf after pulmonary resection and to identify patients at high risk for bpf. The majority of patients present within 3 months postoperatively, most of whom do so within the first 12 days after surgery. Vascular and thoracic surgery of the london hospital between 1953 and 1973 is presented. The low incidence of tuberculosis added to the development of technical and surgical thoracic equipment has greatly decreased its incidence. The use of gelfoam in the management of bronchopleural fistula in a patient with coexisting lung cancer and mycobacterium tuberculosis infection has been reported in 1986. Reconstructive surgery for bronchopleural fistula and. Pneumothorax and bronchopleural fistula request pdf.
Pdf the diagnosis and management of bronchopleural fistula bpf remain a major therapeutic challenge for clinicians. Iatrogenic bronchopleural fistula from a dobhoff tube. Miller jr bronchopleural fistula after lobectomy is fortunately a rare complication. Management of bronchopleural fistula after lobectomy william a. Most barotrauma occurs in patients with trauma, acute respiratory distress syndrome ards, chronic obstructive pulmonary disease copd, asthma, and postthoracic surgery. 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. The approach to treatment depends on the location and size of the bpf, the extent of. Treatment for bpf ranges from medical management to. Bronchopleural fistula bpf remains 1 of the most serious lifethreatening. Here are some important points to be to be remembered. Bronchopleural fistula is an anomalous connection between the bronchial and pleural cavity. Bronchopleural fistula the western journal of emergency.
Bpf most commonly occur after large thoracic surgeries such as pneumonectomy but can occur. Endobronchial treatment of bronchopleural fistulas by using. Use of an amplatzer device for endoscopic closure of a. A bronchopleural fistula bpf is a cavity that develops between the bronchial tree and the pleural space. It is difficult to diagnose and is associated with a high incidence of mortality. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to gain access to this resource from offcampus. Bronchopleural fistula bpf is a pathological communication between the bronchial tree and pleural space. Although rare, bpfs represent a challenging management problem and are associated with high morbidity and mortality.
A pathological connection between the main stem, lobar, or segmental bronchus and the pleural space is termed bronchopleural fistula bpf. A bpf is often a fatal complication of lung surgery postoperatively. Introduction bronchopleural fistula bpf is a sinus tract between the bronchus and the pleural space that may result from a necrotising pneumoniaempyema anaerobic, pyogenic, tuberculous, and fungal, lung neoplasms, blunt and penetrating lung injuries or may. Bronchopleural fistulas are communications between the bronchial tree and the pleural space. Case report the patient was a 60yearold male, a chronic smoker of more than 80 pack years, transferred from an outlying hospital with a onemonth history of shortness of breath and intermittent haemoptysis. The appearance of a bronchopleural fistula is a wellknown and frightening complication of pulmonary surgery. Medical management and therapy of bronchopleural fistulas in. Bronchopleural fistula, fiberoptic bronchoscopy, surgery, diagnosis. By placing the catheter inside the defect and then releasing the device.
Occlusion of a postpneumonectomy bronchopleural fistula using the dumon stent. In highrisk surgical patients, endoscopic procedures may serve as a temporary bridge until the patients clinical. Bronchopleural fistula bpf is a sinus tract between the mainstem, lobar or segmental bronchus and the pleural space leading to an air leak from the lung into the pleural space. With prompt recognition and conservative treatment, its likely that the prognosis of bronchopleural fistulas will improve. The society of thoracic surgeons general thoracic surgery database major procedure data collection form version 2. When pleural space is connected with the bronchial tree leads to bronchopleural fistula. It may also develop when large airways are in communication with the pleural space following a large pneumothorax or other loss of pleural negative pressure, especially during positive pressure. Conservative management of postoperative bronchopleural. Tracheobronchial stenting for management of bronchopleural. The latter includes the selfexpandable stent or classic dumon stent. Get a printable copy pdf file of the complete article 529k, or click on a page image below to browse page by page. Different methods have been used to solve this problem conservatively, from bronchial gluing to stent placement. A predictive score for bronchopleural fistula established. Bronchopleural fistula and the role of contemporary imaging.
Bronchopleural fistula following lobectomy for a stage i squamous cell carcinoma 552 endovascular closure of cardiac septal defects, consists of two expandable disks, made of nitinol wire mesh, connected by a central waist. Aspiration pneumonia and subsequent respiratory distress are the main causes of death. Bronchopleural fistula radiology reference article. By far, the postoperative complication of pulmonary resection is the most common cause, followed by lung necrosis complicating infection, persistent. It is defined as an atypical communication between the bronchial and pleural cavities bpf can be classified on the basis of the duration of symptoms as acute, subacute or chronic and on the basis of etiology as accidental penetrating chest wall.
In this case we used a modified y dumon stent in an attempt. Bronchopleural definition of bronchopleural by medical. A bronchopleural fistula is caused by a connection between the pleural space and the consolidated lung. Factors associated with bronchopleural fistula included right pneumonectomy n 23, left pneumonectomy n 8, long bronchial stump n. Bronchopleural fistula this is a most common postoperative complication of lung surgeries and also one of the recently asked questions in dnb respiratory diseases theory exams. Dr chiranjib bhattacharyya associate professor dept. A bronchopleural fistula is a connection between the bronchi or lung parenchyma and the pleural space. It is defined as an abnormal communication between the bronchial tree and the pleural space. It is a source of morbidity and mortality in patients, particularly those who undergo lung resection.
948 995 1327 1459 830 1048 718 1575 715 1442 1204 906 1468 1065 684 1405 1579 304 193 1525 1515 1498 702 145 1369 901 341 1202 163 498 1496 1528 1507 421 1556 590 667 1024 193 40 546 1156 1132 247 942 809 1437 1474 1262 709 698