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Emergency pulmonary resection for pneumonia. High morbidity and mortality
1Department of Thoracic and Cardiovascular Surgery, Parirenyatwa Hospital, Harare, Zimbabwe.
Insights
Emergency pulmonary resection for complicated pneumonia is life-saving but carries high risks. This study highlights the need for urgent surgical intervention in severe cases, despite expected complications.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Complicated pneumonia can lead to severe respiratory compromise and life-threatening complications.
- Pulmonary necrosis and massive hemoptysis are critical indications for surgical intervention.
Purpose of the Study:
- To evaluate the outcomes of emergency pulmonary resection in patients with complicated pneumonia.
- To identify the indications, complications, and mortality associated with this surgical approach.
Main Methods:
- Retrospective review of eight patients undergoing emergency pulmonary resection (pneumonectomy, lobectomy, bilobectomy) over a two-year period.
- Analysis of patient demographics, indications for surgery, surgical procedures, and postoperative outcomes.
Main Results:
- Indications included staphylococcal pneumonia with respiratory insufficiency and enlarging pneumatoceles in children, and massive hemoptysis in adults.
- Two of eight patients died postoperatively (contralateral aspiration, cardiogenic shock).
- Four patients experienced significant postoperative complications, including bronchopleural fistula, pyopneumothorax, and thoracic empyema.
Conclusions:
- Emergency pulmonary resection, often pneumonectomy, may be life-saving for complicated pneumonia with necrosis.
- High morbidity and mortality are associated with this urgent surgical intervention, necessitating careful patient selection and management.
Abstract:
Emergency pulmonary resection was performed because of complicated pneumonia in eight patients (5 pneumonectomies, 2 lobectomies, 1 bilobectomy) over a 2-year period. The patients' age range was 5 months to 43 years. The indications were rapid aggravation of respiratory insufficiency in children with staphylococcal pneumonia and enlarging pneumatoceles, and massive hemoptysis in patients with chronic destructive pneumonia. Two patients died after pneumonectomy, one from contralateral aspiration and one from cardiogenic shock. Postoperative complications occurred in four cases--bronchopleural fistula and pyopneumothorax in three and thoracic empyema with massive chest-wall infection in one. Only two patients had an uneventful postoperative course. Complications of pulmonary necrosis in pneumonia may dictate urgent pulmonary resection, often pneumonectomy. Surgery will be life-saving in most cases, but high morbidity is to be expected.