Abstract
BackgroundPost-esophagectomy bronchopleural fistulas can be life-threatening in patients who are exhausted, for example, by surgical stress and pleural infection; therefore, establishment of a reliable surgical procedure is extremely important. We here report a novel procedure entailing muscle flap closure for bronchopleural fistula.Case presentationA 64-year-old man developed a right bronchopleural fistula after esophagectomy. Because he was exhausted by surgical stress and malnourished, we considered reliable surgical closure of the fistula essential. Intraoperatively, it was found to connect with the membranous portion of the right main bronchus. We decided to close the fistula with a pedicled fourth and fifth intercostal muscle flap. After separating the intercostal muscles near the angle of the rib, we passed a muscle flap between the azygos vein and bronchus and sutured it securely to the fistula. The postoperative course was uneventful, and there was no thoracic infection. Postoperative bronchoscopy confirmed the muscle flap had securely closed the fistula.ConclusionsThe route and suturing technique of the intercostal muscle flap to a fistula are important, especially in exhausted patients.
Highlights
Bronchopleural fistulas (BPF), which are defined as direct communications between a bronchus and the pleural space [1, 2], are an infrequent but lifethreatening complication of thoracic surgery [3, 4]
Affected patients are generally exhausted by surgical stress, the BPF, and pleural infection
There were no findings of BPF and empyema, but it was difficult to diagnose the recurrence of esophageal cancer because the muscle flap and esophagectomy site overlapped
Summary
Bronchopleural fistulas (BPF), which are defined as direct communications between a bronchus and the pleural space [1, 2], are an infrequent but lifethreatening complication of thoracic surgery [3, 4]. Affected patients are generally exhausted by surgical stress, the BPF, and pleural infection. The surgeons considered NAC did not achieve downstaging (tumor invasion to lungs and bronchus did not change). It was considered that chest tube thoracostomy would not adequately treat the fistula and thoracic infection; surgery was planned. A fistula affecting the membranous portion of the right main bronchus and a little serous fluid around the fistula were noted (Fig. 3). There were no findings of BPF and empyema, but it was difficult to diagnose the recurrence of esophageal cancer because the muscle flap and esophagectomy site overlapped. BPF improved, ADL of the patient did not improve due to depression He transferred from our hospital to a rehabilitation hospital on POD 76. According to the transferred hospital, there was no evidence indicating BPF and empyema on physical and chest X-ray findings
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