Lobar torsion after pulmonary resection: presentation and outcome.
OBJECTIVE
We reviewed our experience on postoperative lobar torsion.


METHODS
Between January 1972 and January 1998, 7887 patients underwent pulmonary resection at our institution. Seven (0.089%; 4 women and 3 men; median age, 68 years) patients required surgical reintervention for lobar torsion.


RESULTS
The indications for pulmonary resection were non-small cell carcinoma in 5 patients, lymphoma in 1 patient, and metastatic prostate carcinoma in 1 patient. The right upper lobe was resected in 3 patients, the left lower lobe in 2 patients, and the right middle and right lower lobe in 1 patient each. Postoperative radiographs demonstrated pulmonary infiltrates and volume loss in 5 patients and complete opacification in 2 patients. The median white blood cell count was 10.6 x 10(9) cells/L (range, 9.3-14.9 x 10(9) cells/L), and the median peak temperature was 38.4 degrees C (range, 37.8 degrees C-40.2 degrees C) during the first 48 hours postoperatively. The diagnosis of lobar torsion was made a median of 10 days (range, 2-14 days) after the initial operation; 4 patients underwent completion pneumonectomy, and 3 had lobectomy. Median hospitalization was 24 days and ranged from 10 to 56 days. There were no postoperative deaths. Complications after reoperation included respiratory failure in 2 patients, atrial arrhythmia in 2 patients, and empyema, urinary tract infection, and a transient ischemic attack in 1 patient each.


CONCLUSIONS
Lobar torsion represents a difficult diagnostic dilemma in the early postoperative period after pulmonary resection. A high index of suspicion is necessary to avoid a delay in treatment. Late diagnosis results in further pulmonary resection and prolonged hospitalization in the majority of cases.
Cable
D G
DG
Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
Deschamps
C
C
Allen
M S
MS
Miller
D L
DL
Nichols
F C
FC
Trastek
V F
VF
Pairolero
P C
PC
D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000175:diagnosis* / Q000601:surgery*; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000175:diagnosis / Q000601:surgery