Localization and treatment of bronchopleural fistula through capnography.

Bronchopleural fistula (BPF) is a feared complication in the setting of pneumonectomy, lobectomy, and pulmonary infection. The development of BPFs significantly increases morbidity and mortality, and their treatment is complicated, multifaceted, and variable in success. Recently, the use of fibrin glues, acrylic glues, and endobronchial valves through bronchoscopy has allowed for minimally invasive treatment, sparing the patient surgical intervention. Results in the literature for these modalities have been mostly positive in a variety of clinical scenarios. Regardless of the therapeutic interventions used, proper diagnosis and localization of these fistulas is essential. These modalities have traditionally included installation of methylene blue in the pleural space, balloon occlusion, and ventilation scintigraphy. Here, we report the successful localization and treatment of a BPF through the use of localized bronchoscopic capnography in a 30-year-old woman with a complicated BPF. Initial attempts to localize the fistula with Fogarty catheter balloon occlusion were unsuccessful, as multiple segments were involved. Ultimately, with a capnographic catheter, the precise segments could be identified and subsequently occluded with acrylic glue. Air leak and pneumothorax resolved, chest tubes were removed without complication, and the patient was discharged 2 days after the procedure.

Colonoscopy-associated pneumothorax: a case of tension pneumothorax and review of the literature.

A 64-year-old woman presented with severe abdominal pain and was found to have a large fecolith in the sigmoid colon with resulting bowel obstruction. During a therapeutic colonoscopy, she developed severe shortness of breath and hypoxia, and was found to have a tension pneumothorax. We review the potential mechanisms by which pneumothorax may occur following colonoscopy. In addition, the eight previously published cases are reviewed. Pneumothorax, with or without pneumomediastinum, can occur through a variety of mechanisms following colonoscopy. Although rarely reported, this may represent an underappreciated complication and should be fully investigated in the appropriate setting. Colonoscopy, an exceedingly common procedure, will continue to increase with the aging population. As a result, tension pneumothorax can have a profound effect on the patient outcome and therefore physicians, both gastroenterologists and pulmonologists, should be aware of all the potential problems with this procedure.