Management of tuberculous destroyed lung in Nigeria

Between 1969 and 1979, 20 patients under-went pneumonectomy for tuberculous destroyed lungs (TDL) at the University College Hospital (UCH), Ibadan, Nigeria. Their ages ranged from 9 to 57 years, with an average age of 24 years. The left lung was involved in 16 patients (80 percent) and the right lung in four patients (20 percent). All patients had received treatment for pulmonary tuberculosis (PTB) for over three years, and all patients had negative cultures of acid-fast bacilli (AFB) at the time of operation. Pulmonary function studies were performed in 15 patients, bronchography in 18, and pulmonary angiography in four. Ninteen patients had elective resection because of mild to moderate hemoptysis without mortality. The only death occurred in a 37-year-old man who had emergency resection because of massive hemoptysis. He died intraoperatively of cardiac arrest. One patient developed bronchopleural fistula (BPF), empyema, and wound infection. The fistula closed spontaneously following prolonged chest drainage and pleural irrigation with antibiotics and antituberculous drugs. As a result of our experience with pulmonary tuberculosis in our environment, the authors now recommend elective resection for patients with TDL in order to prevent massive hemoptysis which may prove fatal.