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Post-pneumonectomy bronchopleural fistula: complex surgical repair for a high mortality case

Devender Singh, Shegu Gilbert, Manohar Arumugam, Paulvannan Subramanian, Sivakumar Mk, Srinivasa Ramachandra
  • Devender Singh
    Department of Cardiothoracic Surgery, Kovai Medical Center and Hospital, Coimbatore, India
  • Shegu Gilbert
    Department of Cardiothoracic Surgery, Kovai Medical Center and Hospital, Coimbatore, India | shegugilbert@yahoo.co.in
  • Manohar Arumugam
    Department of Plastic Surgery, Kovai Medical Center and Hospital, Coimbatore, India
  • Paulvannan Subramanian
    Department of General Surgery, Kovai Medical Center and Hospital, Coimbatore, India
  • Sivakumar Mk
    Department of Cardiac Anesthesia, Kovai Medical Center and Hospital, Coimbatore, India
  • Srinivasa Ramachandra
    Department of Cardiac Anesthesia, Kovai Medical Center and Hospital, Coimbatore, India

Abstract

Post-pneumonectomy empyema and bronchopleural fistula are dreaded complications of thoracic surgery. The associated mortality and morbidity is very high. When treatment is delayed secondary complications are more likely and survival is adversely affected. These conditions require early diagnosis and a wellplanned multi-disciplinary team approach for effective management. We present a patient with post-pneumonectomy empyema and bronchopleural fistula following pneumonectomy for post tuberculosis destroyed lung. He underwent debridement of the empyema cavity, double layer closure of the bronchial stump and reinforcement with omental flap and pectoralis major flap was used to obliterate the space. Debridement and pedicle flaps are safe and effective in the definitive management of postpneumonectomy empyema and bronchopleural fistulae.

Keywords

Empyema; Pneumonectomy; Tuberculosis; Fistula

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Submitted: 2015-12-22 16:44:56
Published: 2016-11-16 09:44:42
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