Progressive chest wall bleeding caused by bronchial stump nails after lobectomy

Postoperative intrathoracic active bleeding is a serious complication after general thoracic surgery. Yet, progressive chest wall bleeding caused by a bronchial stump nail after lobectomy has rarely been reported. The purpose of this report was to review the causes, surgical treatment, and prevention of progressive chest wall bleeding caused by a bronchial stump nail in patients after lobectomy.

Between January 2011 and February 2013, approximately 5,000 patients underwent lobectomies for various thoracic diseases in the Department of Thoracic Surgery of Shanghai Pulmonary Disease Hospital in China. Among the 5,000 patients, four required reexploration for progressive postoperative chest wall bleeding caused by bronchial stump nails.

Staples were used without covers for the bronchial stumps in these patients. At the time of reoperation, we noted that the main site of bleeding was the pleura corresponding to the bronchial stump. The bleeding pleura sites were coagulated and sutured, and complete hemostasis of the pleura was achieved. The nails on the staple that may have caused the bleeding were removed. Then, muscle or hemostatic material was applied to separate the bronchial stump and corresponding pleura.

Performing surgery carefully and understanding the risk from bronchial stump nails are keys to preventing progressive postoperative bleeding.