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[Acute empyema with intraoperative intractable air leaks in a child; report of a case]

Kozo Matsushita1, S Ohi, H Shimota

  • 1Department of Thoracic Surgery, Iwata City Hospital, Iwata, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|February 18, 2006
PubMed

Insights

This study presents a novel technique for managing intractable air leaks in pediatric acute empyema using fibrin glue and polyglycolic acid felt. The method successfully sealed air leaks, enabling lung recovery and patient discharge.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Acute empyema in children, particularly from Staphylococcus aureus, presents significant management challenges.
  • Conventional treatments like antibiotics and chest tube drainage are often insufficient for severe cases.
  • Video-assisted thoracoscopic surgery (VATS) is a key intervention for empyema management.

Observation:

  • A 4-year-old girl with Staphylococcus aureus parapneumonic empyema experienced intractable intraoperative air leaks during VATS.
  • The parietal pleura was notably fragile due to the severe pneumonia, preventing successful closure with sutures or ligations.
  • Standard surgical techniques failed to control the persistent air leaks.

Findings:

  • A novel technique involving fibrin glue-soaked bioabsorbable polyglycolic acid felt sheet was successfully employed to seal intractable air leaks.
  • This innovative approach led to prompt lung expansion in the pediatric patient.
  • The patient was discharged on postoperative day 34 without any complications.

Implications:

  • This case highlights a potentially effective method for managing challenging intraoperative air leaks in pediatric empyema.
  • The use of fibrin glue and PGA felt offers a promising solution for pleural defects unresponsive to traditional methods.
  • This technique may improve outcomes and reduce morbidity in pediatric thoracic surgical emergencies.

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