A 52-years-old man with pulmonary hypofunction had a squamous cell lung
carcinoma and underwent the right upper lobectomy.
Bronchial fistula with
lung abscess developed on the 6th post-operative day. So, the right middle and lower lobectomy (completion
pneumonectomy) were done. But,
bronchial fistula again appeared at the time of weaning from
respirator. It increased in size to about 4.0 x 2.0 cm. Then, transposition of an omental pedicle flap for closure on a wide
bronchial fistula, and muscular plombage and
thoracoplasty for semifilling up a secondary
empyema cavity were performed. On bronchoscopy performed 14 days after operation, the
fistula was completely closed, and the transposed omentum did not project into the trachea. We accomplished our first aim to close the wide
bronchial fistula with omentum. However, he died 59 days after the 3rd operation because we failed to control infection of the remaining
empyema cavity of about 100 ml. The management of an
empyema cavity remains to be a difficult therapeutic problem.