Related Experiment Videos
Postpneumonectomy oesophagopleural fistula
Insights
Oesophagopleural fistula after pneumonectomy is a challenging complication. Surgical repair following initial empyema treatment is the recommended approach for these difficult cases.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Gastroenterology
Background:
- Oesophagopleural fistula (OPF) following pneumonectomy presents significant therapeutic challenges.
- OPF can manifest as early or late presentations, often with associated empyema.
Observation:
- This study reports three new cases of OPF after right-sided pneumonectomy, occurring one month, four years, and 21 years post-surgery.
- All presented with empyema, highlighting the delayed onset potential.
- Diagnostic methods include identifying food particles in pleural fluid, methylene blue instillation with oesophagoscopy, barium swallow, and helium pleural gas identification.
Findings:
- The study adds to the 49 previously published cases of OPF.
- Confirmed OPF in three distinct late-onset cases post-pneumonectomy.
Implications:
- Early diagnosis and management of empyema are crucial.
- Surgical repair of the oesophagopleural fistula is presented as the preferred treatment of choice after initial empyema management.
- This approach offers a viable solution for a complex post-pneumonectomy complication.
Abstract:
Patients with oesophagopleural fistula after a pneumonectomy present a difficult therapeutic problem. There are two types of presentation, early and late. We report three cases in addition to the 49 previously published. All three patients developed their fistulae after right-sided pneumonectomy (one month, four years, and 21 years respectively) and presented with the features of an empyema. The existence of an oesophagopleural fistula can be demonstrated by the discovery of food particles in the pleural aspirate, by direct visualisation during oesophagoscopy after instilling methylene blue into the pleural cavity, by barium swallow, or by identification of helium in the pleural space after swallowing a mouthful of helium. After the initial treatment of empyema we believe that surgical repair of the oesophagopleural fistula is the treatment of choice.