초록접수 현황
| 17F-224 | 포스터 발표 |
Surgical Management of Left Tuberculous Destroyed Lung with Bronchial Stent and Bronchopleural Fistula: A Case Report
Seung Hyuk Nam, Sun Kyun Ro
Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
Purpose : Unilateral lung destruction is rare but one of most severe complication of pulmonary tuberculosis(TB). We present the case of a 42-year-old woman treated with TB medication and left bronchial stent at the age of 18, who needed repeated surgeries due to recurrent bronchopleural fistula(BPF) and uncontrolled infection.
Methods : In July 2015, the patient presented with left chest wall pain. She had no respiratory symptom but chest radiograph showed tuberculous destroyed lung and air-fluid level, and CT scan suggested BPF. Following thoracoscopic exploration, left pneumonectomy was performed. 2 months later, pus was observed on thoracotomy wound and Pseudomonas aeruginosa was identified. Thoracoscopic empyema irrigation was performed but there was no evidence of BPF. 4 months later, BPF on left main bronchial stump was diagnosed. Eloesser flap operation was performed and maintained for 5 months. She underwent trassternal transpericardial left bronchus revision and modified Clagett procedure 14 months after the pneumonectomy. Left main bronchial stent was not completely removed despite two surgical and one bronchoscopic attempts. In the last operation, we instilled fibrin glue into the remaining left main bronchus.
Results : Over 5 months of follow-up, no recurrence was noticed.
Conclusion : In this case, the cause of unsuccessful closure of BPF was unclear. However, we strongly suspected that remained stent played an important role. It would be helpful to prevent stent migration by using fibrin glue, if removal of bronchial stent is impossible at the time of pneumonectomy.
Methods : In July 2015, the patient presented with left chest wall pain. She had no respiratory symptom but chest radiograph showed tuberculous destroyed lung and air-fluid level, and CT scan suggested BPF. Following thoracoscopic exploration, left pneumonectomy was performed. 2 months later, pus was observed on thoracotomy wound and Pseudomonas aeruginosa was identified. Thoracoscopic empyema irrigation was performed but there was no evidence of BPF. 4 months later, BPF on left main bronchial stump was diagnosed. Eloesser flap operation was performed and maintained for 5 months. She underwent trassternal transpericardial left bronchus revision and modified Clagett procedure 14 months after the pneumonectomy. Left main bronchial stent was not completely removed despite two surgical and one bronchoscopic attempts. In the last operation, we instilled fibrin glue into the remaining left main bronchus.
Results : Over 5 months of follow-up, no recurrence was noticed.
Conclusion : In this case, the cause of unsuccessful closure of BPF was unclear. However, we strongly suspected that remained stent played an important role. It would be helpful to prevent stent migration by using fibrin glue, if removal of bronchial stent is impossible at the time of pneumonectomy.
책임저자: Seung Hyuk Nam
Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
발표자: Seung Hyuk Nam, E-mail : seunghyuk.nam@gmail.com