Baloon catheter and omental pedicle flap used in conjuction for treating high-flow bronchopleural fistulae complicated under mechanical ventilation following lower and middle lobectomy.

概要

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The development of a bronchopleural fistula (BPF) after thoracic surgery is a devastating complication for patients who have undergone positive pressure ventilatin. A 73-year-old male patient needed mechanical ventilation with a PEEP because of pneumonia after middle and lower lobectomy for lung cancer. A BPF was found on the 22nd postoperative day. After chest tube placement, an emergency operation was conducted to close the BPF with an omental pedicle.<BR>Unfortunately, high-flow air leakage developed after a few days of mechanical ventilation. A simple method using a balloon catheter was devised to occlude the BPF. The catheter was introduced through the tracheostomy, and the balloon was inflated with 1.5 ml of air at the fistula under fiberbronchoscopic control.<BR>BPF was never a significant problem after insertion of the catheter. Three months after treatment, pneumonia was noted to have subsided. Deflating the balloon did not lead to air leakage from the fistula, and the catheter was removed. Chest X-rays still showed pleural thickening, but no pleural infection, indicating that the BPF had been closed successfully.