Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural Fistula
A postpneumonectomy bronchopleural fistula is a life-threatening complication requiring aggressive treatment and early repair. Reoperations are common due to initial treatment failure. Advanced bronchoscopic techniques are rapidly evolving, but permanent results are questionable. We report the minim...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Pulmonology |
| Online Access: | http://dx.doi.org/10.1155/2021/5513136 |
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| author | Kostas Kostopanagiotou Dimitrios Filippiadis Efthimios Bakas Costas Thomas Andreas Kostroglou Santaitidis Elias Tatiana Sidiropoulou Sotirios Tsiodras Periklis Tomos |
| author_facet | Kostas Kostopanagiotou Dimitrios Filippiadis Efthimios Bakas Costas Thomas Andreas Kostroglou Santaitidis Elias Tatiana Sidiropoulou Sotirios Tsiodras Periklis Tomos |
| author_sort | Kostas Kostopanagiotou |
| collection | DOAJ |
| description | A postpneumonectomy bronchopleural fistula is a life-threatening complication requiring aggressive treatment and early repair. Reoperations are common due to initial treatment failure. Advanced bronchoscopic techniques are rapidly evolving, but permanent results are questionable. We report the minimally invasive management of a frail 79-year-old patient with postpneumonectomy fistula in respiratory failure due to repeated infections. Previous bronchoscopic closure attempts with fibrin failed. The multistep interdisciplinary management included airway surveillance by virtual bronchoscopy, percutaneous fibrin glue instillation under computed tomography, and awake thoracoscopic surgery to achieve temporary closure. This provided an acceptable long period of symptomatic and physical improvement. The bronchial stump failed again four months later, and the patient succumbed to pneumonia. Pneumonectomy has to be avoided unless strongly indicated. Complications are best managed with surgery for definite treatment. We emphasize our approach only when a patient declines surgery or is medically unfit as a temporary time-buying strategy in view of definite surgery in a high-volume center. |
| format | Article |
| id | doaj-art-82ecaf5afcc64c40b7a1235bc578e6fc |
| institution | OA Journals |
| issn | 2090-6846 2090-6854 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pulmonology |
| spelling | doaj-art-82ecaf5afcc64c40b7a1235bc578e6fc2025-08-20T02:08:46ZengWileyCase Reports in Pulmonology2090-68462090-68542021-01-01202110.1155/2021/55131365513136Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural FistulaKostas Kostopanagiotou0Dimitrios Filippiadis1Efthimios Bakas2Costas Thomas3Andreas Kostroglou4Santaitidis Elias5Tatiana Sidiropoulou6Sotirios Tsiodras7Periklis Tomos8Thoracic Surgery Department, Attikon University Hospital of Athens, Greece2nd Radiology Department, Attikon University Hospital of Athens, GreeceThoracic Surgery Department, Attikon University Hospital of Athens, Greece4th Department of Internal Medicine, Attikon University Hospital of Athens, Greece2nd Department of Anesthesiology, Attikon University Hospital of Athens, GreeceThoracic Surgery Department, Attikon University Hospital of Athens, Greece2nd Department of Anesthesiology, Attikon University Hospital of Athens, GreeceDepartment of Epidemiological Surveillance and Intervention, Hellenic Centre for Disease Control and Prevention, University of Athens, GreeceThoracic Surgery Department, Attikon University Hospital of Athens, GreeceA postpneumonectomy bronchopleural fistula is a life-threatening complication requiring aggressive treatment and early repair. Reoperations are common due to initial treatment failure. Advanced bronchoscopic techniques are rapidly evolving, but permanent results are questionable. We report the minimally invasive management of a frail 79-year-old patient with postpneumonectomy fistula in respiratory failure due to repeated infections. Previous bronchoscopic closure attempts with fibrin failed. The multistep interdisciplinary management included airway surveillance by virtual bronchoscopy, percutaneous fibrin glue instillation under computed tomography, and awake thoracoscopic surgery to achieve temporary closure. This provided an acceptable long period of symptomatic and physical improvement. The bronchial stump failed again four months later, and the patient succumbed to pneumonia. Pneumonectomy has to be avoided unless strongly indicated. Complications are best managed with surgery for definite treatment. We emphasize our approach only when a patient declines surgery or is medically unfit as a temporary time-buying strategy in view of definite surgery in a high-volume center.http://dx.doi.org/10.1155/2021/5513136 |
| spellingShingle | Kostas Kostopanagiotou Dimitrios Filippiadis Efthimios Bakas Costas Thomas Andreas Kostroglou Santaitidis Elias Tatiana Sidiropoulou Sotirios Tsiodras Periklis Tomos Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural Fistula Case Reports in Pulmonology |
| title | Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural Fistula |
| title_full | Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural Fistula |
| title_fullStr | Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural Fistula |
| title_full_unstemmed | Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural Fistula |
| title_short | Combining Minimally Invasive Techniques in Managing a Frail Patient with Postpneumonectomy Bronchopleural Fistula |
| title_sort | combining minimally invasive techniques in managing a frail patient with postpneumonectomy bronchopleural fistula |
| url | http://dx.doi.org/10.1155/2021/5513136 |
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