A Case Report of Right Empyema with Fistula in an Elderly Patient with Underlying Disease Treated with Thoracoplasty and Bronchial Occlusion Resulting in a Cure

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 45; no. 4; pp. 262 - 268
• Main Authors: Suzuki, Makoto, Yamada, Hiroyuki, Ikeda, Koei, Fujino, Kosuke, Tanaka, Hidekazu, Masuda, Yoshiko
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.07.2023; 特定非営利活動法人 日本呼吸器内視鏡学会
• Subjects: Bronchial artery embolization; Bronchial occlusion; Empyema with fistula; Rectus abdominis myocutaneous flap; Thoracoplasty; 有瘻性膿胸; 気管支充填術; 気管支動脈塞栓術; 胸郭成形術; 腹直筋皮弁
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.45.4_262

Background. The usefulness of the omentum and the importance of the volume of the myocutaneous flap have often been reported in radical surgery for empyema with fistula. Case. An 82-year-old man, 165.7 cm height and 45.4 kg body weight, had undergone cardiac gastrectomy for gastric cancer. He had diabetes mellitus as an underlying disease. Two years after resection of the right middle lobe for lung cancer, he developed right empyema with fistula due to pneumonia in right lung and received open-window thoracotomy. At 1.5 years later, he developed hemoptysis and was emergently hospitalized. Compression of gauze and administration of hemostatic agents did not completely stop the bleeding. Embolization of the bronchial artery, intercostal artery, and lateral thoracic artery was performed. He wished to undergo additional surgery because a small amount of hemoptysis persisted even after embolization, so thoracoplasty was performed using flaps of the latissimus dorsi, rectus abdominis and intercostal muscle. However, due to slight persistent air-leakage, bronchial occlusion using an Endobronchial Watanabe Spigot (EWS) was performed, and the air leakage disappeared. The patient was then discharged home without recurrence. Six months later, the pneumonia worsened, and the air content in the lungs gradually decreased, so the EWS was removed, but no recurrence was observed. Conclusion. Excellent outcomes were obtained by combining thoracoplasty using rectus abdominis myocutaneous flaps with bronchial occlusion, even in an elderly patient with no great omentum and little muscle mass.