Management of Chronic Empyema Cavity in Cachectic Patients: Review of 30 cases

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Background: An empyema, or empyema thoracis, is a collection of purulent material in the pleural space. The management and presentation varies considerably by managing physician, geographic location, and economic resources.                                                                                                                                                                                                                                 Objectives: The aim of this study was to re‐emphasize the importance of open drainage in the treatment of advanced thoracic empyema and to assess it's effectiveness in patients who did not respond to more conservative treatment  like tube thoracostomy and/ or are not fit for major surgical interventions like thoracotomy.   Patients and Methods: The current retrospective study was carried out in the Cadiothoracic and Vascular  Unit in Ibn- Al-Nafees Teaching Hospital ( Iraq / Baghdad )   &  AL-Hussein Teaching Hospital ( Iraq / Thi-Qar )  from April 2009 to February 2017. The  number of patients included in the study was (30) patients. Most of our patients were too cachectic to tolerate thoracotomy for decortication or more aggressive treatment. We treated them by open drainage with rib resection.Thoracoplasty was added to some of them.   Results: The highest incidence of chronic non-resolving empyema cavity was among patients between (41-60) years old. The commonest type of surgical procedure applied on patients was Elloeser flap whithout   thoracoplasty. Certain Co-morbidities could be recognized in patients with chronic empyema cavity like D.M., Hypertension, Ischemic heart disease & Malignancy. The duration after which the open drainage system closes varies widely between the patients depending on several factors like ( size of chronic empyema cavity, the presence of co-morbidities, adherence to antibiotics, the presence  of bronchopleural fistula, etc…).   Conclusion: The surgical procedure of Modified Elloeser flap was very effective in treatment of chronic empyema cavity in patients who did not respond to more conservative treatment  like tube thoracostomy and/ or are not fit for major surgical interventions like thoracotomy. Open drainage should not be ignored as one of  the therapeutic options in treatment of advanced thoracic empyema. It might be the best therapeutic modality in cachectic patients where the facilities for more aggressive treatment are not possible.