title: Intractable obstructive endobronchial granulation caused by surgical materials after sleeve resection for tracheal carcinoma.
abstract: A 64-year-old woman underwent tracheal sleeve resection for adenocarcinoma. Thirteen months later minimal granuloma occurred at the anastomosis. Subsequently she had dyspnea from obstruction caused by the increasing size of the granuloma, which necessitated 4 repeated endobronchial debulking procedures and topical mitomycin C (MMC) application. However, the symptoms and granulation failed to resolve. Eventually, the granulation tissue and pledgeted sutures were removed from the anastomotic site using rigid bronchoscopy. Follow-up after 8 months showed no recurrence of symptoms, and the granuloma had resolved. Despite improvements in surgical suture material, removal of stitches should still be considered in the management of anastomotic obstruction caused by indolent and intractable granulation after tracheal resection or bronchoplasty.
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. Electronic address: ssasada@ncc.go.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Sasada
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Izumo
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Christine
authors.initials: C
authors.lastname: Chavez
authors.affiliation: Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shun-ichi
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tsuchida
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001999:Bronchoscopy; D005260:Female; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D013536:Suture Techniques / Q000009:adverse effects*; D014132:Trachea / Q000473:pathology* / Q000601:surgery; D014134:Tracheal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014135:Tracheal Stenosis / Q000209:etiology* / Q000473:pathology