Cases reported "Bronchial Fistula"

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1/91. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case.

    We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.
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2/91. Developing bronchial fistulas as a late complication of extraperiosteal plombage.

    A 65-year-old male, who underwent extraperiosteal plombage for pulmonary tuberculosis 46 years ago, was referred to our hospital due to relapsing hemosputa and pneumonia. A chest computed tomography scan revealed a bronchial fistula and a fluid collection in one Lucite ball. On May 20, 1996, a right-anterior thoracotomy was performed in a supine position. Five Lucite balls were removed, and the empyema space was tightly filled with an omental pedicle flap. Although the bronchial fistulas were not sutured directly, the air leakage from the drainage tube ceased 12 days later. Two years postoperatively the patient has remained well. Our simple approach of combining an anterior thoracotomy and replacement of an empyema space with an omental pedicle flap in the same posture, without closing bronchial fistulas, would be an easy procedure, and therefore exploitable in patients who have a similar problem.
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3/91. Fatal hemoptysis in dissecting aortic aneurysm and salmonellosis: a case report.

    hemoptysis is a rare manifestation of dissecting aortic aneurysm and aortobronchial fistula may occur when an aortic aneurysm is mycotic, atherosclerotic, traumatic or postoperative. Aortobronchial fistulas are generally fatal if not treated surgically. An aggressive diagnostic approach to patients with hemoptysis and prompt surgical intervention in those suspected of aortobronchial fistulas should result in additional survivors. Imaging studies, including chest radiography, chest computerized tomography, arteriography and bronchoscopy provide useful diagnostic information. However, challenges remain when we encounter this condition. Sometimes, the final exsanguinating hemorrhage is preceded by a distinct prodromal period of intermittent hemoptysis. This allows clinicians time to recognize such fistulas and perform emergency surgery. We present a patient with this condition to alert clinicians to this potentially deadly cause of hemoptysis.
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4/91. nitric oxide and high frequency jet ventilation in a patient with bilateral bronchopleural fistulae and ARDS.

    PURPOSE: To describe a method of delivering nitric oxide during high frequency jet ventilation. CLINICAL FEATURES: A 63-yr-old man underwent reduction pneumoplasty for bullous emphysema. Postoperatively, ventilation was inadequate, secondary to bilateral high output bronchopleural fistulae. High frequency jet ventilation was initiated and achieved adequate ventilation (pH>7.2). Over the following 24 hr, progressive hypoxemia (SaO2 <86%) developed along with the acute respiratory distress syndrome. nitric oxide was delivered by continuous flow at the patient Y-connector during combined high frequency jet and conventional ventilation (two conventional low volume breaths/minute). Substantial improvement in oxygenation (FiO2 0.8 0.5, SaO2 >92%) was noted initially and was sustained over 72 hr. Subsequently, the patient was weaned to conventional ventilation without difficulty. Mechanical ventilation was discontinued on postoperative day sixteen. CONCLUSION: The simultaneous use of nitric oxide and high-frequency jet ventilation was used safely and effectively in this patient as a method of support for acute respiratory distress syndrome with co-existing large bilateral bronchopleural fistulae.
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5/91. Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula.

    The anaesthetic management of a left pneumonectomy in a 18-month-old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period.
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6/91. Gastric seromuscular and omental pedicle flap for bronchopleural fistula after pneumonectomy.

    We report a case of postpneumonectomy bronchopleural fistula treated using a gastric seromuscular and omental pedicle flap and maintaining good postoperative respiratory function. A 76-year-old man underwent right pneumonectomy with regional lymph node dissection for squamous cell carcimoma of the lung. Five weeks later, a bronchopleural fistula occurred. empyema with the bronchopleural fistula was diagnosed and chest tube drainage implemented immediately. Despite the drainage, signs of inflammation persisted and the patient's nutrition did not improve leading to surgery, on August 18, 1997. The bronchopleural fistula was closed by horizontal suture proximal to the stapling sutured line. A gastric seromuscular and omental pedicle flap was sutured as a cover over the bronchial stump. Postoperative analysis of respiratory function and arterial blood gas showed good results.
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7/91. A rare complication of surgical management for esophageal tumor: a non neoplastic belated fistula between stomach and main right bronchus.

    The fistula between stomach and bronchus after surgery for cancer of the esophagus is a rare occurrence. We describe a gastric non neoplastic ulceration that arose late after six years from an esophagectomy, with an end-side cervical esophagogastrostomy, for a spino-cellular carcinoma. After the partial failure of surgical technique, of the endoscopic treatment and for the bad general conditions of patient we decided to treat the fistula by transluminal drainage. This technique involved a progressive resolution of the fistula, becoming, nowadays, in our division, the preferred treatment for these kinds of postoperative complications.
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8/91. Treatment of postoperative bronchobiliary fistula by nasobiliary drainage.

    Bronchobiliary fistula (BBF) is a rare condition. It may present as a complication of echinococcal or amebic liver disease. Management of such a fistula can be very difficult and is often associated with a high rate of morbidity and mortality. We report the case of a 70-year-old woman who presented with a BBF after a one-stage operation for hydatid cysts of the liver and lung that were approached via thoracotomy and transdiaphragmatic incision. The cause of the BBF was an inflammatory collection in the residual liver cavity due to inadequate drainage. This collection eroded the sutured diaphragm, and because of the existing adhesions, it perforated directly into the bronchial system at the area of the previous cystectomy. Initially, endoscopic sphincterotomy was performed to achieve biliary decompression by equalizing intrabiliary and duodenal pressure, but no significant improvement was seen. Subsequently, nasobiliary drainage was instituted by means of an endoscopically inserted, nasobiliary catheter, which further reduced biliary pressure and facilitated biliary flow to the duodenum, as opposed to the fistulous tract. The fistula was successfully closed in a short time. This conservative method reduces the risks of reoperation. Therefore, it should be considered the treatment of choice in the management of bronchobiliary fistula.
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9/91. Congenital bronchoesophageal fistula and tracheoesophageal fistula with esophageal atresia.

    A case of initial esophageal atresia and tracheoesophageal fistula in a female newborn, later complicated by pneumonia and a second bronchoesophageal fistula, is reported. She was treated surgically by closure of the tracheoesophageal fistula and by end-to-end esophago-esophageal anastomosis. An esophagram at 1 month of age was normal. Three months later she developed severe, persistent right lower lobe pneumonia that required intensive antibiotic therapy and respiratory support. Esophagography was repeated and revealed a second fistula between the right main-stem bronchus and the lower esophagus. The bronchoesophageal fistula was repaired, and a right lower lobectomy was performed. Postoperative recovery was uncomplicated. Histologic examination indicated that the fistula was congenital in origin. To the best of our knowledge, this is the first reported case of a congenital bronchoesophageal fistula coexisting with a tracheoesophageal fistula and esophageal atresia.
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10/91. Management of an intrabronchial rupture of right main pulmonary artery: a case report.

    We report a case of massive endobronchial hemorrhage following a fistula formation of the right pulmonary artery to the right mainstem bronchus in a 15-year-old girl. The fistula had occurred 39 days after the patient had undergone bilateral lung transplantation for cystic fibrosis. The post-transplantation course was remarkable for bronchial colonization by aspergillus at the site of right bronchial anastomosis and an episode of spontaneous, self-limited hemoptysis on postoperative day 17. A massive endobronchial hemorrhage during surveillance bronchoscopy occurred 39 days after transplantation. Immediate intervention, including rigid bronchoscopy followed by surgery, was effective in saving the patient. The pathophysiologic hypothesis to explain the fistula of the right pulmonary artery to the right mainstem bronchus probably involves ischemia of the anastomosis with necrosis of the suture zone complicated by endobronchial infection with aspergillus. Rigid bronchoscopic intervention associated with an excellent medical surgical collaboration was pivotal in successfully rescuing the patient.
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