A Case of Bronchial Occlusion Treated with EWS for Empyema with a Bronchial Fistula Under Mechanical Ventilation

DOI 2 Citations
  • Kajiura Koichiro
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Takizawa Hiromitsu
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Tsuboi Mitsuhiro
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Toba Hiroaki
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Nakagawa Yasushi
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Kawakami Yukikiyo
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Sakiyama Shoji
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Kondo Kazuya
    Department of Oncological Medical Services, Institute of Health Bioscience, The University of Tokushima Graduate School
  • Tangoku Akira
    Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School

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Other Title
  • 人工呼吸器管理中の慢性有瘻性膿胸に対してEWSを用いた気管支充填術を施行した1例

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Abstract

Background. Endoscopic bronchial occlusion with an Endobronchial Watanabe Spigot (EWS) is a less invasive procedure for occluding bronchial fistula in patients with a poor general condition who are not suitable for surgical procedures. Case. An 84-year-old man was diagnosed with a skin-empyema cavity fistula in the precordia due to chronic empyema associated with a bronchial fistula. We performed bronchial occlusion using EWS to occlude the bronchial fistula, after which the air leakage decreased and the skin fistula closed. Nevertheless, the patient developed severe bilateral aspiration pneumonia after expectorating the EWS materials while coughing. A thoracic drain was inserted through the skin fistula; however the volume of air leakage was too great to ensure an effective tidal volume after the drainage. We therefore performed bronchial occlusion with EWS again. The patient was able to obtain an effective tidal volume under mechanical ventilation, he was promptly weaned from the mechanical ventilation treatment. Conclusions. Bronchial occlusion with EWS is an effective and less invasive treatment for empyema associated with a bronchial fistula under mechanical ventilation.

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