A Case of Empyema with Bronchopleural Fistula Treated by Omentoplasty and Bronchial Occlusion with Silicone Spigots

DOI 3 Citations
  • Tsuboi Mitsuhiro
    Department of Thoracic and Endocrine Surgery and Oncology, Tokushima University
  • Miyoshi Takanori
    Department of Surgery, Tokushima Municipal Hospital
  • Aoyama Mariko
    Department of Surgery, Tokushima Municipal Hospital
  • Hino Naoki
    Department of Surgery, Tokushima Municipal Hospital
  • Sakiyama Shoji
    Department of Thoracic and Endocrine Surgery and Oncology, Tokushima University
  • Kondo Kazuya
    Department of Oncological Medical Services, Tokushima University
  • Tangoku Akira
    Department of Thoracic and Endocrine Surgery and Oncology, Tokushima University

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Other Title
  • 難治性有瘻性膿胸に気管支塞栓術を併用した有茎大網充填術が有効であった1例

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Background. Secondary pneumothorax with interstitial lung disease (ILD) is intractable because of susceptibility to infection and insufficiency of tissue healing by treatments with steroid hormones and immunosuppressants, therefore it can frequently lead to chronic empyema with bronchopleural fistula. The primary treatments for pleural empyema are intercostal tube drainage and antibiotics, in a refractory case an open-window thoracostomy is performed to control drainage and infection control. It is often not able to close the wound of an open-window thoracostomy in a patient with respiratory insufficiency. Here, we describe a patient with ILD affected by right pleural empyema with bronchopleural fistula. Case. A man in his 60s who had been treated for acute exacerbation in ILD with steroid hormones and antibiotics had right pneumothorax and received pleural drainage. Bronchial occlusion by silicone spigot and closure of the fistula were not effective. The pleural empyema was diagnosed after surgery by culture test of the pleural effusion which was positive for Aspergillus. After 13 days from the first operation we performed omentoplasty with bronchial occlusion with silicone spigot. The postoperative course was uneventful with no air. Conclusion. There is a possibility that omentoplasty can be more successful by using bronchial occlusion together when infection is not controlled.

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