A case of perforation of the ascending aorta after thoracoplastic surgery which was treatment of right postpneumo nectomy empyema with bronchial fistula

Abstract

A 63-year-old man had a right pneumonectomy for bronchogenic carcinoma. His pathological stage was T₁N₂M₀, Stage III A, squamous cell carcinoma.
Empyema with bronchial fistula developed on the 81st POD.
After 70 days of tube drainage, he underwent thoracoplastic surgery (modified operation of Wilms) and omentopexy. From the 60 th day after reoperation, the empyema cavity disappeared on computed-tomography of the chest, and the bronchial stump has been covered with normal bronchial mucosa bronchoscopically.
But he suddenly died of perforation of the ascending aorta on the 110 th day after the reoperation. We thought that the cause of perforation was injury by costal edge.
When using the modified operation of Wilms, we think that muscle covering of costal edge is necessary to avoid injury to the mediastinal organs by ribs.