Bronchial Stump Coverage Using a Free Pericardial Fat Pad to Prevent Fistula Formation: A Case Report

Bronchial stump fistulas develop into emergent and fatal conditions, so covering the bronchial stump with autologous tissues has been performed to prevent bronchial stump fistula. Covering the bronchial stump with a free pericardial fat pad is a technically simple and minimally invasive procedure. A 72-year-old man underwent left pneumonectomy for primary lung cancer with preoperative comorbidities associated with the risk of bronchopleural fistula, where coverage of the bronchial stump with a free pericardial fat pad was used. The histopathological diagnosis was small-cell carcinoma, and chemotherapy was initiated. Computed tomography performed 52 days postoperatively revealed a small amount of air in the fat pad, indicating bronchial stump dehiscence. The patient was asymptomatic and carefully continued chemotherapy. Five months later, empyema occurred, but fistula formation was avoided because the fat pad served as a separator. Coverage with a free pericardial fat pad can prevent fistula formation by separating the bronchial stump and thoracic space, even if bronchial stump dehiscence occurs.