Delayed bleeding due to a sharp protruding edge of the endostaplers after a wedge resection of the lung: a case report

Abstract

BackgroundEndoscopic devices often cause device-related surgical morbidities such as postoperative bleeding. Delayed bleeding due to a protruding edge of an endostapler has not been previously described in the literature.Case presentationAn 80-yr-old man with a second primary lung cancer underwent a wedge resection of the right lower lobe. He developed sudden hypotension and massive bleeding from the chest tube 4 h after the surgery and underwent an emergency reoperation. A torn parietal pleura was found to have caused a persistent bleeding. There was a sharp protruding edge created by multiple firings of the endostapler. The subsequent lung expansion would have promoted a direct contact between the edge and parietal pleura resulting in delayed bleeding.ConclusionsA protruding edge due to multiple firings of an endostapler could injure the parietal pleura and cause delayed bleeding after a lung resection. This type of injury would be more common in wedge resection cases because of the larger residual lung volume preserved, which is expected to have a better lung expansion and facilitate the direct contact of the staple line and parietal pleura.