The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Acute empyema treated with pulsed lavage irrigation and curettage in cases with persistent dead space: A report of two cases
Shun IwaiAika FunasakiAtsushi SekimuraNozomu MotonoKatsuo UsudaHidetaka Uramoto
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2020 Volume 34 Issue 1 Pages 6-12

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Abstract

Case 1: The patient was a male patient aged 70 years old who had been observed for benign pleural effusion associated with asbestos exposure for 3 years. After a sudden increase in pleural effusion was observed, chest drainage was started in the internal medicine department; however, pleural effusion persisted. Surgery was performed due to antibiotic resistance. We performed pruritus as well as small thoracotomy. High-pressure lavage with pulse lavage irrigation involving 10 L of saline was performed at the end of the operation. The drain was removed on the 11th postoperative day and the patient was discharged on the 16th postoperative day.

Case 2: The patient was a male patient aged 74 years old who had a history of surgery for right-sided breast cancer. Two years previously, he developed right-sided cancer pleurisy and was treated with chemotherapy. Surgery was subsequently performed as the patient developed empyema. Thoracoscopic surgery was performed to remove as much of the pleural cavity as possible, and high-pressure irrigation using pulse lavage irrigation with 8 L of saline was performed at the end of the operation. The drain was removed on the second postoperative day and the patient was discharged on the seventh postoperative day. Both cases had chronic pleural effusion and the dead space did not resolve completely; however, it was possible to successfully treat the patients by performing pruritus to treat the empyema followed by high-pressure lavage with a pulse lavage system. If a dead space remains, reheating of the empyema may be a concern; however, as in the present cases, empyema can be cured by achieving a state that is as sterile as possible at the time of surgery using high-pressure cleaning with pruritus and a pulse cleaning device. We report two cases of successful pulse lavage system application for acute empyema and discuss the relevant literature.

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© 2020 The Japanese Association for Chest Surgery
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