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Background <p>Post-pneumonectomy bronchopleural fistula (BPF) is a life-threatening event whose treatment is not standardized.</p> Case presentation <p>We report the management of a 28-year-old patient with a 3-year history of BPF complicating right pneumonectomy for congenital emphysema. Despite closure by an Amplatzer device, the patient had chronic pyothorax and severely deteriorated general health and quality of life. An attempt at Amplatzer device removal through an open window thoracostomy failed. A median sternotomy was performed, the carina was resected, and the left main bronchus was anastomosed to the trachea. The thoracostomy was closed using fasciocutaneous pedicled flaps. At 9&#xa0;months, the patient was doing well.</p> Conclusion <p>The utilisation of an Amplatzer device to close a broncho-pleural fistula can have adverse effects and potentially result in fatal sepsis in those cases where it is unsuccessful. The endoscopic treatment of BPF should be reserved for expert centers, considering the location, size, and stability of the fistula when choosing the treatment strategy. The surgical management of failed Amplatzer closure may be extremely complex, requiring a highly experienced team.</p>

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Surgery for chronic pyothorax after failed amplatzer closure of bronchopleural fistula

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月16日

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  • Yohann Vincent,
  • Alessandra Lenzini,
  • Amir Hanna,
  • Nicolas Leymarie,
  • Brendan Le Picault,
  • Elie Fadel

摘要

Background

Post-pneumonectomy bronchopleural fistula (BPF) is a life-threatening event whose treatment is not standardized.

Case presentation

We report the management of a 28-year-old patient with a 3-year history of BPF complicating right pneumonectomy for congenital emphysema. Despite closure by an Amplatzer device, the patient had chronic pyothorax and severely deteriorated general health and quality of life. An attempt at Amplatzer device removal through an open window thoracostomy failed. A median sternotomy was performed, the carina was resected, and the left main bronchus was anastomosed to the trachea. The thoracostomy was closed using fasciocutaneous pedicled flaps. At 9 months, the patient was doing well.

Conclusion

The utilisation of an Amplatzer device to close a broncho-pleural fistula can have adverse effects and potentially result in fatal sepsis in those cases where it is unsuccessful. The endoscopic treatment of BPF should be reserved for expert centers, considering the location, size, and stability of the fistula when choosing the treatment strategy. The surgical management of failed Amplatzer closure may be extremely complex, requiring a highly experienced team.