Two Cases of Successful Bronchoscopic Intervention for Bronchial Stump Fistula with Polyglycolic Acid Sheet and Fibrin Glue

Abstract

Background. Postoperative bronchial stump fistula and pyothorax are difficult to manage. Recently various bronchoscopic interventions have been reported. Case 1. A 72-year-old man developed a pyopneumothorax after right lower lobectomy and wedge resection of middle lobe. Bronchoscopy showed a bronchial fistula 3 mm in diameter at the right lower bronchial stump. Polidocanol was bronchoscopically injected to the fistula but it was ineffective. Polyglycolic acid sheet with fibrin glue was inserted into the fistula over and over, and finally air-leakage stopped. This patient is free from relapse of pyopneumothorax 26 months after the bronchoscopic intervention. Case 2. A 67-year-old man developed pyothorax after left lower lobectomy and thoracic curettage was performed. Bronchoscopy revealed necrosis of the left lower bronchial stump and micro fistula. The bronchoscopic intervention with polyglycolic acid sheet and fibrin glue resulted in the closure of the fistula. This patient died of meningitis carcinomatosa 9 months after the intervention without relapse of pyothorax. Conclusion. Bronchoscopic intervention for bronchial stump fistula with polyglycolic acid sheet and fibrin glue is simple and effective method.