title: Refractory empyema caused by an intraoperative rib fracture sustained during esophagectomy: report of a case.
abstract: A 57-year-old woman underwent esophagectomy with three-field lymphadenectomy for lower esophageal cancer, followed by gastric roll reconstruction through the posterior mediastinum. A laparotomy and right thoracotomy with partial resection of the right fifth rib were performed. A purulent discharge requiring drainage developed postoperatively and continued for 3 months despite anastomotic integrity and the absence of a bronchopleural fistula. An empyema developed 3 months after drain removal, and a thoracostomy tube was reinserted. A displaced fragment of the right fifth rib was identified within the abscess cavity. Drainage and irrigation were not curative, and removal of the bone fragment was performed 18 months after the initial procedure. The patient has been symptom-free during 1 year of follow-up. We believe that the rib fragment functioned as a foreign body, which complicated treatment of the patient's postoperative infection.
authors.affiliation: Kozu Hospital, 3-2-7 Kawarayamachi, Chuo-ku, Osaka 542-0066, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Kiyotoshi
authors.initials: K
authors.lastname: Inoue
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kakinoki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Akira
authors.initials: A
authors.lastname: Uemichi
mesh_terms: D004653:Empyema / Q000000981:diagnostic imaging / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008875:Middle Aged; D012253:Rib Fractures / Q000150:complications / Q000209:etiology*; D013908:Thoracotomy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed