Acute Lung Abscess Causing Staple-Line Failure and Metalloptysis after Bullectomy: A Case Report

Stapled bullectomy is a safe procedure for primary spontaneous pneumothorax (PSP). Early infection-driven staple-line failure with metalloptysis after bullectomy for PSP is rare. A 21-year-old man underwent video-assisted thoracoscopic bullectomy for persistent right PSP. The staple lines were reinforced with polyglycolic acid sheets. The early postoperative course was uneventful, but the patient developed fever, cough, and purulent sputum on postoperative day 21. Computed tomography demonstrated fluid-filled cavitary lesions along the staple lines in the right upper and lower lobes, with partial staple-line disruption. Sputum cultures yielded oral commensals, and an acute lung abscess associated with staple-line failure was diagnosed. Antibiotic therapy was initiated, and he expectorated several surgical staples. The abscess resolved with conservative treatment. This case suggests that acute infection along pulmonary staple lines can lead to staple-line failure and metalloptysis even after routine bullectomy. Persistent postoperative fever or purulent sputum should prompt careful evaluation for staple-line-associated infection.