Case report
Closure of bronchopleural fistulas using Albumin-Glutaraldehyde tissue adhesive

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Abstract

Bronchopleural fistulas are a life-threatening complication of pulmonary resection. A 21-year-old woman developed a large bronchopleural fistula after undergoing a pneumonectomy for carcinoid tumor. Despite bronchial stump revision and omental coverage, the fistula recurred. The second patient is a 42-year-old woman with a history of multiple thoracotomies who developed a bronchopleural fistula following aortic root replacement. Using either rigid bronchoscopy or thoracoscopy, these fistulas were evaluated and sealed with an albumin-glutaraldehyde tissue adhesive that may have improved strength and biocompatibility compared with other tissue sealants. This approach may be an effective alternative in the treatment of bronchopleural fistulas.

Section snippets

Patient 1

A 21-year-old woman underwent a right pneumonectomy for a carcinoid tumor involving the right mainstem bronchus, which was transected just above the origin of the upper lobe. One-month later, she developed an empyema and underwent tube thoracostomy. Bronchoscopy revealed a large fistula at the medial aspect of the bronchial stump. Although the air leak initially subsided with the application of fibrin, it recurred the following day. On final pathology, the pneumonectomy margin was positive for

Comment

Bronchopleural fistulas occur in 0.8% to 15% of patients after pneumonectomy [2] and can have devastating consequences including aspiration pneumonia and empyema with a mortality between 29% and 71% [1]. Factors that predispose to fistula formation include chemotherapy or radiation therapy, positive margins, a long bronchial stump, right pneumonectomy, and postoperative mechanical ventilation 1, 2. Excessive dissection, resulting in tissue ischemia, and tension on the bronchial suture line can

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