A Case of Postoperative Pulmonary Fistula Possibly Caused by Contact with the Reinforcement Material for an Automatic Stapler

Abstract

A 33-year-old man presented to our hospital with right chest pain and dyspnea on exertion. A chest X-ray showed a right pneumothorax, and the patient was treated conservatively. However, the lung collapse worsened, and, therefore, thoracoscopic surgery was performed. Multiple lung cysts were found in the right upper lobe, and a cyst was found on the edge of the right middle lobe ; the cysts were removed using an automatic stapler with reinforcement. The right upper lobe resection line was covered with a polyglycolic acid (PGA) sheet. No air leak was observed after surgery, but a slight air leak appeared a few hours later. The air leak did not stop, so a reoperation was performed. A leak test showed a leak in the interlobar surface of the right lower lobe, and lung damage was found at the same site. It was exactly at the position where the reinforcement of the staple stump of the right middle lobe was in contact. Therefore, the cause was thought to be contact with the reinforcement material for an automatic stapler.