A Case of Post-surgical Bronchial Fistula Successfully Managed with Glue Through the Fiberoptic Bronchoscope

Abstract

We reported a case of post-surgical bronchial fistula which was successfully managed with glue administered through the fiberoptic bronchoscope. The patient was an 82-year-old man and admitted to the National Okinawa Hospital with fever, cough and sputa. Chest X-ray film showed right lower lobe atelectasis. Bronchoscopy revealed a tumor originating from the right lower lobe bronchus, which had been shown to be a squamous cell carcinoma by biopsy. Right middle and lower bilobectomy was performed. Twelve days after operation the patient had fever and chest X-ray showed air-fluid level in the right pleural cavity, indicating a bronchopleural fistula and empyema. Fiberoptic bronchoscope confirmed a fistula of the surgical stump of the truncus intermedius. An intercostal tube drain was inserted and antibiotics were administered. Ten days after drainage we attempted to close the fistula with glue administered through the fiberoptic bronchoscope. After the injection of an antibiotic to the fistula, Oxycel^[○!R] was inserted to the fistula and 0.5cc of α-cyanoacrylate (Aron Alpha A) glue was injected through an epidural catheter which was inserted in advance via the instrumentation channel of fiberoptic bronchoscope. The air leak through the drain ceased and empyema was cured. Two months later fiberoptic bronchoscope revealed no evidence of fistula. The patient died of cancer recurrence 25 months after operation.