A surgical case of secondary pneumothorax cured by intra-fistula filling method using fibrin glue and PGA felt

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The patient was a 73-year-old male who had been treated for lung cancer located in the left lower lobe (S9-10), evaluated as cT2aN2M0. He received chemoradiotherapy, which involved combination chemotherapy with carboplatin and paclitaxel, and radiotherapy of 50.0 Gy for the primary lesion. Diffuse radiation pneumonitis and fibrosis were seen in his left lower lobe, 3 months after the therapy. In addition, left pneumothorax was recognized a month after that. Because conservative therapy using chemical pleurodesis for this secondary pneumothorax ended in failure, surgical intervention was performed. A pulmonary fistula of about 1 cm in diameter was present in part of the primary lung cancer. Due to lung parenchyma hardening and its fragile visceral pleura, we performed the intra-fistula filling method using fibrin glue and PGA felt, which was followed by direct suturing and reinforcement of the visceral pleura. This reinforcement outside visceral pleura was achieved using a fascia patch and the combination of PGA felt and frictional spraying of fibrin glue. This intra-fistula filling method using fibrin glue and PGA felt can be effective when a standard surgical procedure for pneumothorax using an autosuturing device cannot be performed.