A Case in Which the Removal of Endobronchial Watanabe Spigots Was Extremely Difficult After Long-term Placement

Abstract

Background. In recent years, the usefulness of bronchial occlusion with Endobronchial Watanabe Spigots (EWSs) in the treatment of intractable pneumothorax or pulmonary fistula has been reported; however, there are few reports about the removal of EWSs. Case. The patient was a 49-year-old man who had previously undergone surgical treatment for right pneumothorax. Bronchial occlusion with EWSs had been performed to treat postoperative pulmonary fistula of a left emphysematous giant bulla. Although EWSs had been placed for the long-term, the patient experienced chest discomfort and we tried to remove them at one year after occlusion. Due to the influence of postoperative change and long-term placement, it was difficult to approach the left superior division, which was target objective bronchus. In addition to multiple bronchoscopes, a single-use video bronchoscope facilitated manipulation at the sub-area branch level with forceps. Finally, we successfully removed all of the EWSs without complication. Conclusion. The removal of EWSs may be difficult depending on the state of the bronchus and patient factors. The combined use of a single-use bronchoscope can be useful in cases in which EWSs are difficult to move.