2024 Volume 38 Issue 6 Pages 561-566
Bronchopleural fistula is one of the most serious complications after lung cancer surgery and often requires surgical management. Herein, we present a case of successful conservative management of complete dehiscence of the bronchial stump with localized pyothorax. A 70-year-old otherwise healthy woman underwent thoracoscopic right lower lobectomy with lymph node dissection for lung adenocarcinoma (cT1bN0M0). Pleurodesis was performed for persistent air leak, and she was discharged 11 days after surgery. She developed a bronchopulmonary fistula with complete dehiscence of the bronchial stump 15 days after surgery, but the pyothorax cavity was confined to the mediastinal side due to pleural adhesion. Inflammation reduced after CT-guided drainage and initiation of antibiotic therapy. Although spontaneous closure of the transection did not occur, purification of the lumen was maintained and the drain was removed on the 75th postoperative day. The presence of bronchial epithelium within the organizing lumen of the blind end indicated that the patient was cured. Conservative treatment may obviate the need for open surgery if drainage of the localized pyothorax can control the infection, while also taking into consideration the indications for open surgery.
