Case report on peri-operative surgical and anaesthetic management of ruptured humongous lung abscess. (August 2022)

• Record Type: Journal Article
• Authors: Siddiqui, Khalid Maudood; Azizullah, Akbar; Yousuf, Muhammad Saad
• Is Part Of: International journal of surgery case reports. Volume 97(2022)
• Publication Date: 2022-08
• Subjects: Lung abscess -- Lung resection -- Video assisted thoracoscopy (VATS) -- Peri operative management -- Thoracic empyema; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107381
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: Early thoracic empyema is usually treated through video-assisted thoracoscopic (VATS) decortication. Patient selection is important for decortication if an effective surgical outcome is required. Lung isolation techniques are required to provide anesthesia for these patients to facilitate the surgeon while operating on the affected lung. The ultimate target is to protect the non-diseased contra-lateral lung from contamination. Presentation of case: We are presenting a unique case of 20-year-old female, resident of Karachi, who was brought to the emergency room (ER) with signs of sepsis, hypotension, and multi-organ failure. She was brought to the operating room to undergo video-assisted thoracoscopy (VATS) for lung abscess decortication when her medical therapy had failed. On table decision of right upper lobe resection was made and ventilation strategy had to be modified accordingly. Discussion: The main anaesthetic aim was to protect the healthy parts of the lung from the abscess. Regular suctioning of secretions during surgery via the double lumen tube (DLT) lumen on the diseased side is recommended. While performing VATS, the lung abscess got ruptured and immediate measures to isolate the lung was taken to assist with surgical resection of the affected lobe. Lobectomy can only be done once the lung was completely isolated and maintaining perfusion and ventilation of the relatively healthy lung help in managing hypoxia. Conclusion: Peri-operative management of ruptured lung abscesses required thorough pre-op evaluation, intraoperative lung isolation and ventilation, and postoperative analgesia with combined team effort both surgical and anaesthetic, are vital fundamentals to consider in guaranteeing the best outcome. Highlights: Peri operative management of ruptured humongous lung abscess Combined surgical and anaesthetic team efforts result in a successful outcome More emphasize is needed on high-risk lung abscesses Focused on both peri operative anaesthetic and surgical care