Transanastomotic endobronchial migration of a pericardial flap

A 36-year-old woman underwent left main bronchus sleeve resection for a typical carcinoid. The bronchial anastomosis was reinforced with a bovine pericardial flap fixed by fibrin glue. Six months after the surgery the patient presented with acute dyspnea. Flexible bronchoscopy disclosed an endoluminal migration of the pericardial flap through the anastomotic dehiscence and a cicatricial stenosis of the left upper bronchus. The migrated flap was successfully removed and the stenosis segment of the bronchus was dilated using a rigid bronchoscope. Two months after complete recovery from the bronchial dehiscence, the patient developed an anastomotic cicatricial stenosis, which was effectively treated by laser photoresection and mechanical dilatation. Eight months after the last procedure the patient remains symptom free.