Effective treatment of empyema with bronchopleural fistula after esophagectomy by endobronchial embolization using endobronchial Watanabe Spigots. (2017)

• Record Type: Journal Article
• Authors: Uchida, Shinsuke; Igaki, Hiroyasu; Izumo, Takehiro; Tachimori, Yuji
• Is Part Of: International journal of surgery case reports. Volume 33(2017)
• Page Start: 1
• Page End: 3
• Publication Date: 2017
• Subjects: Empyema -- Bronchopleural fistula -- Esophagectomy -- Endobronchial embolization -- Endobronchial watanabe spigot; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2016.11.025
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: In this case, we emphasized the value of Endobronchial Watanabe Spigot (EWS) use in bronchial embolization. Embolization with EWS is one of the first line options in conservative management of BPF after esophagectomy. We safely retried the 2nd endoboronchial embolization using the EWS. The patient with advanced esophageal cancer, clinical stage was cT3N1M0 stage IIIA was referred to our hospital. He underwent esophagectomy with video assisted thoracic surgery accompanied by reconstruction of the stomach through the posterior sternum after induction chemotherapy. The patient was in good condition and there was no recurrence. The patient was followed six months later, empyema was not occurred and the patient was in good general condition. Abstract: Introduction: Empyema and bronchopleural fistula are well known complications after thoracic surgery. We report a case of refractory air leakage of bronchopleural fistula in a patient with empyema that was successfully treated by endobronchial embolization using Endobronchial Watanabe Spigots (EWSs). Presentation of case: A 71-year-old man underwent esophagectomy for primary esophageal cancer. A right empyema with bronchopleural fistula (BPF) developed four months after surgery. Right thoracic drainage tube was inserted. Although the empyema was treated by drainage and anti-biotics therapy, the air leakage was apparent. The chest computed tomography (CT) scan revealed that the bronchopleural fistula existed in the segment 6 and 10. Endobronchial embolization was performed to the responsible bronchus using EWSs. After the EWSs of middle and large sizes were inserted into the B 6 c and B 10 b + c, the air leakage was stopped. The thoracic tube of drainage was removed after endobronchial embolization. Complications due to the EWSs insertion were not observed, and the patient was discharged. Discussion: The management of BPF has evolved over the years. Surgical approach is frequently needed to control the BPF, though endobronchial embolization is effective in closing the BPF in some patients. In our case, EWSs of middle and large size were useful to control air leakage. We safely retried the 2nd endoboronchial embolization using the EWS. The patient had no complication after insertion the EWS again. Conclusion: Endobronchial embolization using EWSs was an effective treatment of an empyema with bronchopleural fistula after esophagectomy.