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2017 ; 33
(ä): 1-3
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Effective treatment of empyema with bronchopleural fistula after esophagectomy by
endobronchial embolization using endobronchial Watanabe Spigots
#MMPMID28259070
Uchida S
; Igaki H
; Izumo T
; Tachimori Y
Int J Surg Case Rep
2017[]; 33
(ä): 1-3
PMID28259070
show ga
INTRODUCTION: Empyema and bronchopleural fistula are well known complications
after thoracic surgery. We report a case of refractory air leakage of
bronchopleural fistula in a patient with empyema that was successfully treated by
endobronchial embolization using Endobronchial Watanabe Spigots (EWSs).
PRESENTATION OF CASE: A 71-year-old man underwent esophagectomy for primary
esophageal cancer. A right empyema with bronchopleural fistula (BPF) developed
four months after surgery. Right thoracic drainage tube was inserted. Although
the empyema was treated by drainage and anti-biotics therapy, the air leakage was
apparent. The chest computed tomography (CT) scan revealed that the
bronchopleural fistula existed in the segment 6 and 10. Endobronchial
embolization was performed to the responsible bronchus using EWSs. After the EWSs
of middle and large sizes were inserted into the B(6)c and B(10)b+c, the air
leakage was stopped. The thoracic tube of drainage was removed after
endobronchial embolization. Complications due to the EWSs insertion were not
observed, and the patient was discharged. DISCUSSION: The management of BPF has
evolved over the years. Surgical approach is frequently needed to control the
BPF, though endobronchial embolization is effective in closing the BPF in some
patients. In our case, EWSs of middle and large size were useful to control air
leakage. We safely retried the 2nd endoboronchial embolization using the EWS. The
patient had no complication after insertion the EWS again. CONCLUSION:
Endobronchial embolization using EWSs was an effective treatment of an empyema
with bronchopleural fistula after esophagectomy.