A Case of Bronchopleural Fistula Associated with Esophageal Surgery Successfully Closed by Injection of Fibrin Glue under Bronchoscopic Observation

Hiroshi Miyata, Kazuhiro Okagawa, Kentarou Kishi, Kiyonori Nishioka, Toshisada Ukei, Yoshio Uemura, Keisuke Miyauchi, Takashi Terashima, Tadashi Kaneko, Sumio Mizunoya

Department of Surgery, Kinki Central Hospital

Pyothorax associated with esophageal surgery is a disease that is hard to cure. Especially pyothorax with bronchopleural fistula is a more troublesome complication. For bronchopleural fistula, surgical treatments such as plombage with muscle and an omental pedicle flap have been commonly used. However, these surgical methods cannot be chosen after esophageal surgery with stomach reconstruction. We report a case of bronchopleural fistula after esophageal surgery which was succesfully closed by using fibrin glue under bronchoscopic observation. A 61-year-old woman underwent subtotal esophagectomy with stomach reconstruction. Invasion of the main tumor to the carina and the left main bronchus precluded complete tumor resection. On the 12th postoperative day, pyothorax probably caused by the operation was detected. An air leakage continued despite drainage and frequent irrigation in the right pleural cavity. Bronchopleural fistula was diagnosed by the X-ray film in which the B⁶b bronchus was visualized by the contrast medium from the drainage tube. On the 43rd postoperative day, fibrin glue was bronchoscopically injected into the B⁶b bronchus distally by means of a catheter with a balloon by which the orifice of the B⁶b was obstructed to avoid an back flow of the fibrin glue. The air leakage disappeared right after this treatment and the bronchopleural fistula was completely cured.

Key words
esophageal cancer, bronchopleural fistula, fibrin glue

Reprint requests
Hiroshi Miyata Department of Surgery, Kinki central Hospital
3-1 Kurunazuka, Itami, 664 JAPAN

Accepted
December 11, 1996

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