title: Progressive chest wall bleeding caused by bronchial stump nails after lobectomy.
abstract: BACKGROUND
  Postoperative intrathoracic active bleeding is a serious complication after general thoracic surgery. Yet, progressive chest wall bleeding caused by a bronchial stump nail after lobectomy has rarely been reported. The purpose of this report was to review the causes, surgical treatment, and prevention of progressive chest wall bleeding caused by a bronchial stump nail in patients after lobectomy.
  
  
  METHODS
  Between January 2011 and February 2013, approximately 5,000 patients underwent lobectomies for various thoracic diseases in the Department of Thoracic Surgery of Shanghai Pulmonary Disease Hospital in China. Among the 5,000 patients, four required reexploration for progressive postoperative chest wall bleeding caused by bronchial stump nails.
  
  
  RESULTS
  Staples were used without covers for the bronchial stumps in these patients. At the time of reoperation, we noted that the main site of bleeding was the pleura corresponding to the bronchial stump. The bleeding pleura sites were coagulated and sutured, and complete hemostasis of the pleura was achieved. The nails on the staple that may have caused the bleeding were removed. Then, muscle or hemostatic material was applied to separate the bronchial stump and corresponding pleura.
  
  
  CONCLUSIONS
  Performing surgery carefully and understanding the risk from bronchial stump nails are keys to preventing progressive postoperative bleeding.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Disease Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jichen
authors.initials: J
authors.lastname: Qu
authors.affiliation: Department of Clinical Epidemiological Study, Xinhua Hospital, Medical College of Shanghai Jiaotong University, Shanghai, China.
authors.forename: Guangyu
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Disease Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Boxiong
authors.initials: B
authors.lastname: Xie
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Disease Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jiaan
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Disease Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
mesh_terms: D000328:Adult; D001980:Bronchi / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D019106:Postoperative Hemorrhage / Q000209:etiology*; D013525:Surgical Instruments / Q000009:adverse effects; D013896:Thoracic Diseases / Q000209:etiology*