Abstract
Back ground: Bronchial fistulas in cases of inoperable lung cancer caused by radiochemotherapy are quite refractory and generally cannot be surgically closed.
Case: A 45-year-old man with squamous cell carcinoma in the right lung underwent two courses of induction chemotherapy (135mg CDDP, 5mg VDS, 13.5mg MMC) and radiation therapy (2Gy×22 times) for invasion of the right main bronchus, the pulmonary artery and superior vena cava. Just before the end of the second course, the empyem second to the bronchial fistula caused by tumor necrosis developed in the right upper bronchus, and fenestration was performed. After the operation, his condition improved remarkably, however the fistula enlarged into the right main bronchus and the purulent discharge flowed into the left lung. An expandable metallic stent (EMS) covered with polyuretane was inserted in the trachea and the left main bronchus to break aspiration pneumonia. As the covered EMS was too unstable to be fixed, a bare EMS was inserted in a stent-in-stent fashion. After the procedure he was followed at the O. P. D. and lived a relatively comfortable life for 9 months until his death due to tumor.
Conclusion: We inserted the covered EMS in a stent-in-stent fashion to successfully obliterate a large bronchial fistula.
