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Acute Lung Abscess Causing Staple-Line Failure and Metalloptysis after Bullectomy: A Case Report
Yuki Kamiya1, Ryutaro Hanawa1, Takao Shigenobu1,2
1Department of Thoracic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.
Summary
Infection can cause rare staple-line failure after lung bullectomy for primary spontaneous pneumothorax (PSP), leading to abscess and expectorated staples. Persistent fever or sputum post-surgery warrants infection evaluation.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Infectious Diseases
Background:
- Stapled bullectomy is a standard procedure for primary spontaneous pneumothorax (PSP).
- Complications like staple-line failure are uncommon but can be severe.
- Early recognition of infection-related complications is crucial for patient outcomes.
Purpose of the Study:
- To report a rare case of early infection-driven staple-line failure after bullectomy for PSP.
- To highlight the potential for lung abscess and metalloptysis (expectoration of foreign bodies) in such cases.
- To emphasize the importance of evaluating persistent postoperative symptoms for staple-line infections.
Main Methods:
- A case report of a 21-year-old male patient with persistent PSP.
- Video-assisted thoracoscopic bullectomy with staple line reinforcement using polyglycolic acid sheets.
- Postoperative monitoring including computed tomography (CT) scans and sputum cultures.
Main Results:
- The patient developed fever, cough, and purulent sputum on postoperative day 21.
- CT revealed cavitary lesions along staple lines with partial disruption.
- Diagnosis of acute lung abscess secondary to staple-line failure; oral commensals identified in sputum.
- Patient expectorated surgical staples and recovered with antibiotic therapy and conservative management.
Conclusions:
- Acute infection along pulmonary staple lines can lead to rare but serious complications like staple-line failure and metalloptysis.
- Persistent postoperative fever or purulent sputum necessitates thorough investigation for staple-line associated infections.
- This case underscores the need for vigilance even after seemingly routine bullectomy procedures.
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