title: Transsternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury.
abstract: Most common causes of intrathoracic empyema include pulmonary infections and postoperative bronchopleural fistulas complicating a lung surgical resection, mainly pneumonectomy, as a result of the failure of the bronchial stump to heal. A 22-year-old Serbian patient presented with chronic posttraumatic empyema. Two years before during a war, he experienced chest injury due to a firearm wound, with massive intrathoracic bleeding and need for emergency left pneumonectomy. Empyema with a bronchopleural fistula occurred during the postoperative course. The patient underwent left open window thoracostomy with a daily bandage change. Here we report the treatment of the bronchopleural fistula using sequential surgical approach including transsternal transpericardial closure of the fistula followed by reconstruction of the chest wall with a regional muscle flap. Our case report highlights the feasibility and efficacy of the transsternal surgical approach to treat postpneumonectomy bronchopleural fistula, thereby avoiding the direct approach to the bronchial stump through the infected pneumonectomy cavity.
authors.affiliation: Department of Respiratory Medicine, Hôpital Louis Pradel, Hospices Civils de Lyon, France. nggirard@gmail.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girard
authors.forename: Alessandro
authors.initials: A
authors.lastname: Orsini
authors.forename: François
authors.initials: F
authors.lastname: Tronc
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Gamondes
mesh_terms: D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002908:Chronic Disease; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D010369:Pectoralis Muscles / Q000601:surgery; D010496:Pericardium / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects*; D056346:Sternotomy; D013524:Surgical Flaps; D013536:Suture Techniques; D013537:Sutures; D013898:Thoracic Injuries / Q000601:surgery*; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014857:Warfare; D014948:Wounds, Gunshot / Q000601:surgery*; D055815:Young Adult