Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery.

Patient: Male, 60 Final Diagnosis: Iatrogenic intercostal lung hernia Symptoms: - Medication: No medication Clinical Procedure: Surgically cerrected Specialty: Thoracic surgery. OBJECTIVE: Unusual clinical course. BACKGROUND: Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea. CASE REPORT: A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well. CONCLUSIONS: Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery.

Sternal dehiscence accompanied by protrusion of the left lung through the chest wall.

We report an almost complete protrusion of the lung through the anterior chest wall occurring as a complication following sternal dehiscence. Emergency treatment is mandatory since it has a high potential for incarceration, hemopneumothorax, respiratory failure, and infection. Twenty-eight days after coronary by-pass surgery, the left lung of a 66-year-old male patient almost completely protruded through the sternotomy incision in the chest wall; the lung tissue was successfully reduced and the sternotomy was closed. Recurrence was not observed within the 6-month follow-up period, his general condition was good. The clinical course of the patient was retrospectively reviewed, and this case was reported with a unique complication.

Therapeutic bronchoscopic intervention with resector balloon.

In this study a novel therapeutic bronchoscopic technique, balloon bronchoplasty with resector balloon, was used in 128 procedures for 112 consecutive patients with airway obstruction from lung cancer or granulation tissue. All procedures, except 4, were performed with a rigid bronchoscope under general anesthesia. The remainder were performed with a flexible bronchoscope under local anesthesia. In all procedures, balloon bronchoplasty was the primary method and we achieved 100% success with no major immediate or long-term complications. The technique also facilitated submucosal and distal tumor resection. We found balloon bronchoplasty using resector balloon to be a safe, effective, fast, easy, and potentially cost-effective method in the management of airway obstruction from endobronchial submucosal lesions.

A new endoluminal resection technique and device: resector balloon.

PURPOSE: We have developed a new resection technique and designed a special balloon by which resection of endoluminal airway lesions can be safely and successfully done. DESCRIPTION: From April to December 2006, 38 interventions were done in 30 patients; endobronchial tumor or granulation tissues were mechanically removed by a catheter by which the balloon was covered with a polyurethane mesh structure. Acute and long-term complications, results, advantages, and disadvantages of this new technique and device were determined. EVALUATION: Resection of endobronchial tumors and also control of bleeding and dilatations were successfully performed in 30 patients. CONCLUSIONS: As an alternative to other endobronchial treatments, this new technique and device can be used as a safe method. In addition, the utilization of this new device does not need as much experience as other techniques. On the other hand this method does not need very expensive equipment, such as a laser or cryotherapy equipment.