ABSTRACT
La fistula del muñón bronquial es una seria complicación de la neumonectomía, por su complejidad tanto en los cambios anatomofisiológicos que el paciente experimenta, como en la diversidad de recursos para su resolución. El objetivo de este estudio es la presentación de este primer caso en la historia quirúrgica del país de abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial post neumonectomía en el Hospital San Vicente en Guatemala. Método: Se presenta el caso de una paciente de sexo femenino a quien se le realizó neumonectomía derecha por tuberculosis pulmonar y que presentó dehiscencia del muñón bronquial por lo que se procedió a realizar abordaje transesternal transpericárdico para el cierre del muñón bronquial a nivel de la Carina. Resultados: Se da seguimiento a la paciente por 8 años tras los cuales el problema se considera resuelto. Conclusión: la utilización del abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial postneumonectomía permite alcanzar el bronquio en un ambiente no contaminado debiendo considerarse como un procedimiento adecuado para resolver este tipo de complicación.
Background: Bronchial stump fstula is a serious complicaton of pneumonectomy. The aim of this case report is to document the frst surgical patenttreated with trans-sternal, trans-pericardial approach for bronchial stump fstula closing afer pneumonectomy at San Vicente Hospital in Guatemala.Methods: A female patent who underwent right pneumonectomy for pulmonary tuberculosis with postoperatve bronchial stump dehiscence.Trans-sternal trans-pericardial approach was performed for closing the bronchial stump fstula at the carina.Results: Afer 8 years of follow up, the problem in the patent had completely resolved.Conclusion: Trans-pericardial trans-sternal approach for bronchial stump fstula closing allows bronchium access in a non-contaminated space andshould be considered to resolve this kind of complicaton.
Subject(s)
Humans , Female , Bronchial Fistula/complications , Pneumonectomy/adverse effects , Tuberculosis, Pulmonary/surgeryABSTRACT
Postpneumonectomy syndrome is a rare and delayed complication of pneumonectomy. This syndrome is caused by the shifting and rotation of the heart and mediastinum into the empty hemithorax. It can be corrected by inserting prosthesis in the empty side of the chest. We experienced a case of postpneumonectomy syndrome in 17 year-old girl that followed by right pneumonectomy for multi-drug resistance tuberculosis (MDR-TB) 9 months ago. The corrective surgery of postpneumonectomy syndrome does not seem to be familiar with anesthesiologists. We report this case with references, as we were unable to find any case report about this maneuver.
Subject(s)
Adolescent , Female , Humans , Drug Resistance, Multiple , Heart , Mediastinum , Pneumonectomy , Prostheses and Implants , Thorax , TuberculosisABSTRACT
PURPOSE: To evaluate the incidence of postpneumonectomy pulmonary edema (PPE) and determine the risk factors for PPE with non-small cell lung caner. MATERIALS AND METHODS: A group of 93 patients who underwent a pneumonectomy between 1994 and 2004 were retrospectively studied. Postpneumonectomy patients with pulmonary edema, with no clinically evident cause, with the exception of having undergone a pneumonectomy, were considered to have PPE. The incidence and mortality of PPE were recorded. The preoperative, perioperative and postoperative clinical data were reviewed, and the patients matched for known or suspected risk factors for PPE. A logistic regression analysis and Chi-square test were used to evaluate the relationships of the risk factors to the PPE. RESULTS: The incidence of PPE was 7.5% (n=7). The mortality in the group of patients who developed PPE was 86% (n=6). Patients who had fresh frozen plasma administered had a significantly higher incidence of PPE (risk ratio=14.9, p=0.024). CONCLUSION: Fresh frozen plasma (FFP) transfusion after a pneumonectomy was shown to be an important risk factor in our data. The mechanism has not been identified, but may be an increased capillary permeability of the pulmonary vessels due to an immunologic reaction following a FFP transfusion
Subject(s)
Humans , Capillary Permeability , Carcinoma, Non-Small-Cell Lung , Incidence , Logistic Models , Lung , Mortality , Plasma , Pneumonectomy , Pulmonary Edema , Retrospective Studies , Risk FactorsABSTRACT
Postpneumonectomy syndrome is a rare condition characterized by dyspnea due to an extreme mediastinal shift and bronchial compression of the residual lung after a right pneumonectomy or a left pneumonectomy with the right aortic arch. Severe fibrosis of the lung such as tuberculsosis (TB) - destroyed lung can cause similar clinical features in the absence of pneumonectomy. We report a unique case of postpneumonectomy syndrome without pneumonectomy, which was successfully treated with pneumonectomy and mediastinal repositioning with tissue expanders.
Subject(s)
Aorta, Thoracic , Dyspnea , Fibrosis , Lung , Pneumonectomy , Tissue Expansion Devices , Tuberculosis, PulmonaryABSTRACT
Postpneumonectomy syndrome is a rare complication that usually occurs in younger patients within the first year after a right total lung resection. Its clinical presentations are stridor, dyspnea, and recurrent pulmonary infections. An airway obstruction secondary to the extreme mediastinal shift and rotation after a pneumonectomy is the main mechanism. It is commonly complicated with tracheobronchomalacia due to longstanding airway compression. The management modalities involve a repositioning of the mediastinum with volume expansion of the pneumonectomy site by a expandable prosthesis. however, other methods including an endobronchial stent insertion should be considered in the presence of a tracheobronchomalacia or in poor surgical candidates. Here we describe a case of postpneumonectomy syndrome complicated by a bronchomalacia, which was successfully treated with a self-expandable endobronchal stent.