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Gangrene of the lung: treatment in two stages
1Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, Israel.
Background:
Pulmonary gangrene is a rare complication of severe lung infection with devitalization of lung parenchyma and secondary infection. If untreated, gangrene of the lung leads to sepsis, multiple-organ failure, and death. Resection of all gangrenous tissue is mandatory and is lifesaving. Pleural empyema commonly accompanies gangrene of the lung; in its presence, dissection of hilar structures for resection can lead to mediastinitis or bronchopleural fistula and should be avoided.
Methods:
Three patients with pulmonary gangrene were treated in two stages: immediate fenestration first and then delayed resection of gangrenous lung in a clean field and immediate closure of the pleural window.
Results:
Two patients underwent pneumonectomy and 1 patient, lobectomy. All patients recovered without complications.
Conclusions:
Creation of a pleural window (fenestration) for 1 week enables safe and curative resection of a gangrenous lung or lobe in a clean field and in a patient in stable condition.
Insights
This study introduces a two-stage treatment for pulmonary gangrene, a severe lung infection. A pleural window (fenestration) followed by resection allows for safe and effective removal of infected lung tissue.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Infectious Diseases
Background:
- Pulmonary gangrene is a rare, life-threatening complication of severe lung infections.
- Untreated pulmonary gangrene can lead to sepsis, multiple-organ failure, and death.
- Pleural empyema often accompanies pulmonary gangrene, complicating surgical resection.
Observation:
- A two-stage surgical approach was employed for three patients with pulmonary gangrene.
- The first stage involved immediate fenestration to create a pleural window.
- The second stage consisted of delayed resection of gangrenous lung tissue in a clean surgical field.
Findings:
- Two patients underwent pneumonectomy, and one patient underwent lobectomy.
- All three patients recovered successfully without any complications.
- A one-week fenestration period facilitated safe and curative resection.
Implications:
- This two-stage approach, involving a pleural window, enables safer resection of gangrenous lung tissue.
- It allows for curative treatment in a stable patient condition, avoiding complications like mediastinitis.
- This method offers a viable and effective strategy for managing complex pulmonary gangrene cases.