Delayed bronchial perforation after bulla cauterization with soft coagulation system

Area of Science:

• Pulmonology
• Thoracic Surgery
• Medical Device Technology

Background:

• Soft coagulation is a common hemostasis technique, valued for tissue coagulation without carbonization.
• Despite its benefits, rare instances of airway damage following soft coagulation application have been documented.

Purpose of the Study:

• To report an unusual case of delayed bronchial perforation after soft coagulation.
• To highlight the potential risks of thermal damage to airways during procedures adjacent to them.

Main Methods:

• A case of delayed intermediate bronchial trunk perforation, 24 days post-bulla cauterization, was analyzed.
• Diagnostic imaging included chest computed tomography and bronchoscopy.
• Surgical intervention involved resection of the bulla and affected bronchus, followed by anastomosis and muscle flap coverage.

Main Results:

• Chest CT revealed a large fistula between the intermediate bronchial trunk and the cauterized bulla.
• Bronchoscopy confirmed a significant fistula in the membranous portion of the intermediate bronchial trunk.
• The perforation was attributed to thermal damage during the initial bulla cauterization.

Conclusions:

• Severe airway damage, including perforation, can occur without direct electrode contact.
• This case underscores the importance of considering cauterization duration and proximity to airways.
• Enhanced vigilance is necessary when employing soft coagulation near critical airway structures.