Emergency surgery for massive haemoptysis

Massive haemoptysis (600 ml in 24 hours) results in considerable mortality and deserves appropriate management. Since it is life threatening, lung resection remains the surgical treatment of choice in unrelenting haemoptysis.

We retrospectively reviewed all patients (n = 29) who were referred to our clinic between January 1994 to September 2001 with massive haemoptysis (> 600 ml/24 h). All patients had uncontrollable haemorrhage and/or failure of conservative treatment. After initial resuscitation, assuring adequate airway and providing adequate intravenous access, emergency thoracotomy was performed in all patients following rigid bronchoscopy (n = 27) in order to localize the bleeding.

The most common underlying cause of the massive haemoptysis was pulmonary tuberculosis (n = 10) followed by emphysema in 4, lung cancer in 3, collagenous vascular disease in 2 and aspergilloma in one patient. Seventeen lobectomies (58.6%), 5 pneumonectomies (17.2%), 3 segmentectomies and 3 bilobectomies were done whereas physiological lung exclusion was performed in one patient. Haemoptysis could be controlled in all patients. Rate of operative morbidity and hospital mortality were 27.5% and 11.5% respectively. We recorded one patient with recurrent haemoptysis who was treated by completion pneumonectomy.

Despite the debate over definition of massive haemoptysis and indication for surgery in these patients, emergency pulmonary resection provides an effective treatment with acceptable morbidity and mortality in patients with massive haemoptysis.