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| Endoscopic Closure of Bronchopleural Fistula using Glue Therapy: A Case
Report |
| Sandeep Gupta1* and Simica2 |
| 1Consultant Pulmonary and Critical care, Department of Pulmonary Medicine and Critical care, Columbia Asia Hospital, Patiala, India |
| 2Department of Anesthesiology, Columbia Asia Hospital, Patiala, India |
| *Corresponding author: |
Dr. Sandeep Gupta
146, Narula Colony, The lower mall,
Patiala (Pb), India, 147001
Tel: 91-9888391241
E-mail: drsandygupta@yahoo.com |
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| Received July 21, 2011; Accepted September 12, 2011; Published October 19,
2011 |
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| Citation: Gupta S, Simica (2011) Endoscopic Closure of Bronchopleural
Fistula using Glue Therapy: A Case Report. J Pulmonar Respirat Med 1:103.
doi:10.4172/2161-105X.1000103 |
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| Copyright: © 2011 Gupta S, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited. |
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| Abstract |
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| The occurrence of a bronchopleural fistula (BPF) continues to represent a challenging management problem, and
is associated with high morbidity and mortality. Bronchoscopic closure of BPF with instillation of n-butyl-cyanoacrylate
glue is an effective, economical, minimally invasive and safe technique for managing BPFs. We present a case that
was successfully treated with this method. |
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| Keywords |
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| Bronchopleural fistula; Fibreoptic bronchoscopy;
n-butyl-cyanoacrylate |
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| Introduction |
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| Bronchopleural fistula (BPF) is a sinus tract between the
bronchus and the pleural space that may result from a necrotizing
pneumonia/ empyema (anaerobic, pyogenic, tuberculous and fungal),
lung neoplasm, blunt and penetrating injuries, or may occur as a
complication of procedures, such as lung biopsy, chest tube drainage,
thoracocentesis or may complicate radiation therapy. Clinically it is
suspected when the air leak through the underwater drainage system
persists beyond 24 hours of its initiation [1]. Mortality rates vary
between 18% and 67% [2]. The management of BPF is one of the most
complex challenges encountered by the chest physicians. |
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| Case Report |
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| A 52 year old male presented to our emergency department with
the chief complaint of breathlessness. The patient was a known case
of bronchial asthma with allergic bronchopulmonary aspergillosis
(ABPA) and bilateral bronchiectasis. The CT scan showed bilateral
pneumothorax, more on the left side. Both the lungs were cystically
dilated with areas of consolidation. Intercostal chest drainage was
placed on both the right side and left side with persistent air leak was
noticed on right sided drainage bag. A diagnosis of BPF was made and
antibiotics were started. However, his clinical picture did not resolve
with an antibiotic regime and chest tube drainage. At bronchoscopy, the
bronchopleural fistula was observed on the right side with air bubbling
seen from apical segment upper lobe and on wedging the bronchoscope
in right upper lobe segment air bubbling was stopped. After this, 1ml
of n-butyl-cyanoacrylate was applied around the fistula orifice. Still
there was a persistent air leak. Another 1 ml of n-butyl-cyanoacrylate
was applied and the closure of BPF was confirmed with air bubbling
stopped in drainage bag. There was no procedure related complication.
Expansion of the lung was achieved. Intercostal tube was clamped on
3rd post procedure day and a repeat chest radiograph was done after 24
hours of clamping showed no reappearance of pneumothorax and no
bubbling in air bag. The chest tube was removed successfully on the
next morning. On follow up over a period of 2 months, the patient had
no relapse of BPF. |
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| Discussion |
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| BPFs developing as a complication of pleuropulmonary infections
may develop at any point of time during the course of illness. The
patients who present with a BPF developing late or those who develop
the fistula as a complication of suppurative pleuropulmonary diseases
are initially managed medically. Medical management should include
dependent drainage and reduction of the pleural space, antibiotics, nutritional supplementation and adequate ventilatory management if
ventilated [3]. The closure of fistula requires surgical or thoracoscopic
interventions which are difficult to carry out in patients with poor
lung function. In recent years, a number of non-surgical techniques
have been developed for attempting endobronchial closure of BPFs. It
should be noted, however, that the efficacy of the endoscopic repair is
reduced proportionally with increasing fistula diameter. In cases of a
small fistula, or where the surgical risk is high, various bronchoscopic
methods have been used to close the fistula. The glue has got remarkable
safety and simplicity in its application. It solidifies quickly on exposure
to humidity and has got antibacterial effect [4]. Hence, endobronchial
sealing of BPF with cyanoacrylate glue is a plausible solution and the
technique described appears to be reasonably easy as well as effective. |
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| Conclusions |
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| BPF is associated with significant morbidity and mortality.
Treatment of active infection and life threatening complications
should be instituted as early as possible. In cases of smaller fistulas, a
bronchoscopic closure can be attempted with satisfactory result. |
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| References |
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- Sahn SA (1995) Pleural disease in the critically ill patient. Intensive care
Medicine 3: 720-737.
- Hollous PH, Lax F, el-Nashef BB, Hauck HH, Lucciarini P, et al. (1997) Natural
history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg 63: 1391-1397.
- Baumann MH, Sahn SA (1990) Medical management and therapy of
bronchopleural fistulas in the mechanically ventilated patient. Chest 97: 721-
728.
- Giray CB, Us D, Guney C, Araz K (1993) Antibacterial and cytotoxic effects of
N-butyl-2- cyanoacrylate used as a tissue adhesive. Microbiyol Bul 27: 154-
163.
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