2018 Volume 40 Issue 3 Pages 211-215
Background. Bronchial occlusion using Endobronchial Watanabe Spigot (EWS®) is a treatment option for bronchopleural fistula (BPF). Case. A 75-year-old man underwent bronchial occlusion using EWS® for treatment of BPF after right upper lobectomy because omentopexy was ineffective. Since the initial occlusion failed due to EWS® migration, we repeated the procedure. When we adjusted the suction pressure of thoracic drainage to -50 cm H2O, the EWS® fitted the orifice of the fistula and the air leakage disappeared. We continued the high negative pressure suction drainage, and the infection in the empyema reduced with temporal adhesion of the EWS® to the fistula. When the suction drainage pressure was subsequently reduced, the re-inserted EWS® migrated again and the BPF was found to be still present. However, since the surface of the empyema space was uniformly covered with regenerating epithelium after omentopexy, there were no signs of infection even after formation of the internal fistula between the cavity and the right main bronchus. Conclusion. Bronchial occlusion using EWS® with high negative pressure suction drainage is a useful option for the treatment of BPF and relieves the infection in empyema.
