2018 Volume 32 Issue 1 Pages 104-110
A 79-year-old man with malnutrition underwent a right lower lobectomy with mediastinal lymph node dissection for lung squamous cell carcinoma (cT3N1M0 Stage IIIA). On postoperative day 11, he presented with a bronchopleural fistula involving a 5-mm defect with aspiration pneumonia, and underwent open-window thoracostomy. Enhanced nutritional support was implemented for malnutrition and a poor appetite, consisting of enteral nutrients provided via a nasal tube. We increased the nutritional support up to 3,600 kcal/day based on the nutritional index calculated using levels of serum pre-albumin, a rapid-turnover protein. Subsequently, there was significant recovery with granulation and a decrease in the pleural cavity size.
Thoracomyoplasty using the latissimus dorsi was successfully performed 73 days after the open-window thoracostomy. The optimal quantity of nutritional support needed can vary and is based on the clinical condition. Thus, appropriate assessment and intensive care for patients receiving nutritional support may be useful when treating bronchopleural fistula.
