Healing of bronchopleural fistula using a modified Dumon stent: a case report

Our plain-English summary of Healing of bronchopleural fistula using a modified Dumon stent: a case report, by G.M. Ferraroli, A. Testori, U. Cioffi, et al (Journal of Cardiothoracic Surgery, 2006).

The study

• Authors: G.M. Ferraroli, A. Testori, U. Cioffi, M. De Simone, M. Alloisio, M. Galliera, M.M. Ciulla, G. Ravasi
• Journal: Journal of Cardiothoracic Surgery
• Published: 2006;1:16
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Bronchopleural fistula following lung resection is a therapeutic challenge for thoracic surgeons.

Case Presentation: We describe a case of late bronchopleural fistula after right extrapleural pneumonectomy for malignant mesothelioma. Bronchoscopic attempts to repair it were unsuccessful.

Conclusion: The use of a modified Y Dumon stent associated with glue apposition on the bronchial stump allowed us to close the fistula without the need of any surgical repair.

In plain English

This was a case report about one 64-year-old man with pleural mesothelioma. In December 2004 a biopsy taken during thoracoscopy showed epithelioid monophasic pleural mesothelioma, and talc pleurodesis was carried out. Three weeks later he had a right extrapleural pneumonectomy, with the bronchial stump covered by a flap of thymic tissue. The tumor was staged pT3 N0 M0. Ten months later he developed fever and cough, and bronchoscopy showed a 2-mm bronchopleural fistula on the stump. Drainage and antibiotics cured the infection, but an attempt to close the fistula with biological glue failed. The doctors then applied glue over the stump and inserted a modified Y-shaped Dumon stent whose right arm was shortened and closed off. He was discharged on the third day and had no empyema or pneumonitis until he died four months later of pulmonary emboli. Autopsy also found an initial relapse of mesothelioma in the chest wall. The article did not discuss asbestos exposure. The authors concluded that the stent with glue closed the fistula without surgical repair.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 64-year-old man with right recurrent pleural effusion, treated by thoracic surgery departments in Rozzano and Milan, Italy; biopsy in December 2004
• Exposure: Not described: the article does not mention asbestos or the patient's work history. The treatments described were a modified Y Dumon stent and biological glue for a bronchopleural fistula.
• Main results:
  • A thoracoscopic pleural biopsy in December 2004 showed epithelioid monophasic pleural mesothelioma.
  • After right extrapleural pneumonectomy, pathology confirmed monophasic epithelioid pleural mesothelioma with lung and pericardial fat infiltration but no invasion of the diaphragm or pericardium, staged pT3 N0 M0.
  • Ten months after surgery, bronchoscopy showed a 2-mm fistula on the mediastinal side of the bronchial stump.
  • An attempt to close the fistula with biological glue failed, so a modified Y Dumon stent was used.
  • The patient was discharged on the 3rd postoperative day and had no empyema or pneumonitis until he died 4 months later of pulmonary emboli.
  • Post-mortem examination showed a massive thrombus in the left main pulmonary artery and an initial relapse of mesothelioma in the posterior chest wall, without signs of infection.
• The authors' conclusion: The authors concluded that the modified Y Dumon stent combined with glue on the bronchial stump allowed them to close the fistula without any surgical repair. In their opinion, the procedure could be useful for main bronchus pleural fistulas and could be used as a first choice.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Mesothelioma.

Related studies

• Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy — G. Stamatis, G. Martini, et al. (1996)
• Digital quantification of air leak to identify the location of an alveolopleural fistula — T.M. Saettele, C.A. Jimenez (2014)
• Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant — N. Kondo, M. Hashimoto, et al. (2020)
• Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause — F.A. Büstgens, R. Loose, et al. (2017)
• Single site venovenous extracorporeal membrane oxygenation as an alternative to invasive ventilation in post-pneumonectomy fistula with acute respiratory failure — M. Fica, F. Suárez, et al. (2012)
• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy — J. Turtiainen, J.V. Räsänen, et al. (2016)

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