0
Pulmonology Procedures |

Closure of Bronchopleural Fistula by Instillation of Fibrin Glue Under Fiberoptic Bronchoscopy

Boonsong Patjanasoontorn*, MD
Author and Funding Information

Khon Kaen University, Khon Kaen, Thailand


Chest. 2012;142(4_MeetingAbstracts):883A. doi:10.1378/chest.1389963
Text Size: A A A
Published online

Abstract

SESSION TYPE: Bronchology Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: A broncho-pleural fistula (BPF) is a communication between the bronchial tree and the pleural space. BPFs may occur following pulmonary resection, mechanical trauma, malignancy, necrotizing pleuropulmonary infections, or after diagnostic or therapeutic procedure of the chest region. Although persistent bronchopleural fistulas are not very common, they represent a challenging management problem and are associated with high mortality and morbidity.

CASE PRESENTATION: Four cases of persistent bronchopleural fistulae following pulmonary resection, necrotizing pneumonia, bronchioloalveolar cell carcinoma, and lymphangioliomatosis were reported. Bronchoscopic localization of BPFs were done by sequential segmental occlusion with balloon tip cather and selective bronchography. Closure of BPFs were then performed with fibrin glue instillation through double lumen catheter pass through therapeutic channel of fiberoptic bronchoscope. Thrombin and fibrinogen go simultaneously through separated channel of double lumen catheter to the fistulous tract where they met and formed fibrin glue. All BPFs were completely sealed after initial instillation. One patient with BPF from bronchioloalveolar cell carcinoma had relapsed fistula after two week of initial instillation that need further BPF occlusion successfully with cyanocrylate glues.

DISCUSSION: The treatment of BPF includes a variety of surgical and medical procedures. Recently, the advances in minimally invasive methods via interventional bronchoscopic approach yield the promised results especially in patient with limited pulmonary reserve. Sequential segmental balloon occlusion techniques is beneficial for localization of single fistulous tract and selective bronchography could confirmed in the patient who may have two or more fistulae. Injection of thrombin and fibrinogen through separated channel made more glutinous plug at fistula and less contamination through bronchoscopic therapeutic channel.

CONCLUSIONS: Flexible bronchoscopy is an effective tools for localization and management of persistent bronchopleural fistula. Sequential segmental bronchial occlusion and/or selective bronchography is practical and useful for localization of fistulae. Instillation of fibrin glue is effective method for closure of small to moderate size BPFs. This method should be considered as the initial therapeutic options for persistent BPF especially in the patient with limited pulmonary reserve.

1) Goussard, P., Gie, R., Kling, S., Kritzinger, F., van Wyk, J., Janson, J. and Andronikou, S. (2008), Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post-tuberculosis bronchiectasis. Pediatr. Pulmonol., 43: 721-725. doi: 10.1002/ppul.20843

DISCLOSURE: The following authors have nothing to disclose: Boonsong Patjanasoontorn

No Product/Research Disclosure Information

Khon Kaen University, Khon Kaen, Thailand

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543