Intractable air leak after segmentectomy for lung abscess in rheumatoid disease

Abstract

Postoperative air leakage is one of the most common complications after lung resection. Intractable cases due to micro bronchopleural fistula occasionally require reoperation or bronchial embolization. We report a case of intractable air leak after segmentectomy in a patient with rheumatoid disease. A 62-year-old man had been treated for rheumatoid disease by tofacitinib. He developed acute empyema with a fistula after undergoing examination for an abnormal shadow. Computed tomography demonstrated a mass shadow with bronchodilation in the right upper lobe of 49 mm in diameter. Although the causative bacteria were not identified, his disease was diagnosed as a lung abscess. We performed segmentectomy for the lesion. Postoperative air leakage had been prolonged, but we could not identify a micro bronchopleural fistula on reoperation. Air leakage continued after the reoperation. We added omental implantation and performed bronchial embolization using an Endobronchial Watanabe Spigot and cyanoacrylate multiple times. This paper reports a difficult case of controlling postoperative air leakage. Wound healing was poorer than usual, and this case showed a rare clinical course. Tofacitinib may affect wound healing beyond the recommended washout period.