title: Expectoration of the staple line: a delayed complication after previous lobectomy.
abstract: In the literature, bronchopleural fistula after thoracic surgery is usually reported in the perioperative setting; however, the incidence of delayed fistula still remains unknown. We herein report a case of a 54-year old man who was referred to the Emergency Department for dyspnoea and productive cough with expectoration of a whitish 'suture-like' tissue. Two months before, the patient underwent an uneventful right lower lobectomy for squamous-cell lung cancer. A computed tomography scan revealed a para-mediastinal localized pneumothorax (measuring 6 cm in the major axis) starting from a right lower bronchus interruption associated with a middle lobe consolidation. The patient was consequently admitted for respiratory monitoring and underwent a fibre-optic bronchoscopy to assess bronchial integrity: the right lower bronchus was completely dehiscent and connected to an empty pleural closed pouch, with no inflammatory signs or sputum-like effusion. After the procedure, the clinical course was unremarkable with gradual improvement of clinical conditions: in particular, the cough disappeared and no sign of fever, leucocytosis or respiratory failure was observed. Thus, after a multidisciplinary meeting, the patient was discharged 7 days after admission and re-evaluated monthly. Six months after diagnosis, the patient was symptom-free with complete closure of the fistula on radiological imaging.
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy gio.leuzzi@yahoo.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Leuzzi
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Alessandrini
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Forcella
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Facciolo
mesh_terms: D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003371:Cough / Q000209:etiology / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013183:Sputum; D017792:Surgical Stapling / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Bronchial stump; Bronchopleural fistula; Cough; Lobectomy; Staple