Intractable Bronchopleural Fistula After Lung Resection in Mycobacterial Infection; Surgical and Endoscopic Treatment With Fibrin Glue Application Followed by Latissimus Dorsi Musculocutaneous Flap Coverage: A Case Report

Abstract

Postoperative bronchopleural fistula (BPF) is a challenging and complicated problem to cope with. Involving with multidisciplinary care team is essential for the best outcome. This report provides our experiences in intractable BPF after lung resection surgery which fail to completely heal after received surgical and endoscopic treatment. A 56-year-old female with no known underlying disease presented with nonmassive hemoptysis, productive cough, low-grade fever, and significant weight loss for 3 years. Her sputum consisted of Mycobacterium abscessus with multidrug resistant. Radiological examination revealed reticulonodular infiltration at middle lobe of the right lung and lingular lobe of the left lung, also a bronchiectatic change of both lungs. After 3 years of medical treatment, neither of her symptoms nor radiological findings improved. Therefore, a video-assisted thoracoscopic surgery (VATS) with middle lung lobectomy and lingulectomy was performed. After that, BPF at lingular stump occurred. Many surgical and endoscopic techniques followed by latissimus dorsi musculocutaneous flap along with vacuum dressing were introduced to encourage the complete healing of the BPF. One month later, the patient’s clinical was improved and endoscopic findings showed nearly complete healing of the BPF. In conclusion, surgical and endoscopic treatments combined with postoperative vacuum dressing encourage patient’s symptoms to be subsided.