Surgical treatment of empyema after pulmonary resection using pedicle skeletal muscle plombage, thoracoplasty, and continuous cavity ablution procedures: a report on three cases.
We present three cases of postoperative empyema after pulmonary resection: case 1, acute empyema without fistula after lobectomy and chest wall resection; case 2, continuing empyema with fistula and total left residual lung abscess after upper divisionectomy; and case 3, chronic empyema with middle lobe bronchopleural fistula after lower lobectomy. Pedicle skeletal muscle plombage into the cavity, thoracoplasty, and continuous cavity ablution with 24-h instillation of minocycline and saline solution through drains were used for treatment. In case 2, a completion extrapleural left pneumonectomy was concurrently performed. In all three cases, the surgery was successful; however, case 2 developed a massive gastrointestinal hemorrhage, which led to blood aspiration pneumonitis, renal failure, and death. Muscle plombage effectively achieves the closure of empyema cavity and thoracoplasty complements this. When a residual space remains, cavity ablution is considered to be effective. However, concurrent completion lung parenchyma resection might be excessively aggressive.
1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan ; 2 Department of Thoracic Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
Noriaki
N
Sakakura
1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan ; 2 Department of Thoracic Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
Tetsuya
T
Mizuno
1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan ; 2 Department of Thoracic Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
Hiroaki
H
Kuroda
1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan ; 2 Department of Thoracic Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
Yukinori
Y
Sakao
1 Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan ; 2 Department of Thoracic Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
Tatsuo
T
Uchida
Pulmonary resection; cavity ablution; empyema; muscle plombage; thoracoplasty