rome and Bronchial-Fistula

The aim of this study is to assess the frequency and clinical importance of mediastinal tubercular lymphadenitis and adenobronchial fistulas (TABF) and to evaluate the role of fiberbronchoscopy and surgical bronchoscopy associated with antimicrobical chemotherapy. 136 cases of primary pulmonary TBC, admitted to the Unit of Infectious Diseases, Bambino Gesu Children Hospital in Rome, between 1980 and 2001, were enrolled in the study. We considered 56 patients with clinical and radiological evidence of mediastinal tubercular lymphadenitis and 28 patients with adenobronchial fistulas (TABF). The incidence of TABF was 20,58% of primary pulmonary TBC. All patients were treated by medical therapy combined with local endobronchial surgery. TABF emerges as a complication of pediatric primary pulmonary TBC. We suggest a clinical and radiological survey to decide the utility of a diagnostic and therapeutic surgical bronchoscopy

Topics: Antitubercular Agents; Bronchial Fistula; Bronchoscopy; Child; Child, Preschool; Combined Modality Therapy; Female; Fistula; Humans; Infant; Italy; Male; Mediastinal Diseases; Retrospective Studies; Rome; Tuberculosis, Lymph Node

Bronchopleural fistula is a rare but potentially fatal complication of pulmonary resections and proper management is essential for its resolution. In this study, we analyzed the incidence of fistula after pulmonary resection and reported data about endoscopic and conservative treatments of this complication.. From January 2003 to December 2013, 835 patients underwent anatomic lung resections: 786 (94.1 %) had a lobectomy and 49 (5.9 %) a pneumonectomy. Bronchopleural fistula was suspected by clinical signs and confirmed by endoscopic visualization.. Eighteen patients (2.2 %) developed a bronchopleural fistula, 11 in lobectomy group (1.4 %) and 7 in pneumonectomy group (14.3 %). The fistula size ranged between <1 mm and 6 mm and mean time of fistula onset was 33.9 ± 54.9 days after surgery. Of 18 patients who developed fistula, one died due to acute respiratory failure and another one was reoperated and then died to causes unrelated to the treatment. All the remaining 16 patients were treated with a conservative therapy that consisted in keeping or replacing a drainage chest tube. Nine of them underwent also endoscopic closure of the fistula using biological or synthetic glues. The mean period of time elapsed for the resolution of this complication was shorter with combined (conservative + endoscopic) than with conservative treatment alone (15.4 ± 13.2 vs. 25.8 ± 13.2 days, respectively), but without significant difference between the two methods (p: 0.299).. Endoscopic therapy, associated with a conservative treatment, is a safe and useful option in the management of the postoperative bronchopleural fistula.

Topics: Aged; Bronchial Fistula; Bronchoscopy; Chest Tubes; Drainage; Female; Humans; Incidence; Male; Middle Aged; Pleural Diseases; Pneumonectomy; Reoperation; Respiratory Tract Fistula; Rome; Time Factors; Treatment Outcome

The aim of the study was to assess the feasibility, efficacy and safety of the use of a conical self-expandable stent for the treatment of post-pneumonectomy bronchopleural fistula (PPBPF). Between April 2008 and November 2010, six patients underwent treatment for the PPBPF by the introduction of a tracheobronchial conical fully covered self-expandable nitinol stent with the aim of excluding the bronchial dehiscence from the airflow. We secured the prosthesis to the tracheal mucosa with titanium helical fasteners tacks. Five patients presented with a bronchial fistula larger than 5 mm following right (4) or left (1) pneumonectomy. One patient had an anastomotic dehiscence after right tracheal sleeve pneumonectomy. A chest tube showed the absence of empyema in all cases. Immediate resolution of the bronchial air leak was obtained in all the patients. Permanent closure of the bronchial dehiscence without recurrence was achieved in all the patients at a mean follow-up time of 13 months (range 3-32). The bronchial stent was successfully removed in all patients without sequelae 71-123 days after its implantation. The use of the conical self-expandable Silmet(®) stent has proved to be an effective, safe and fast method to treat even large PPBPFs.

Topics: Aged; Alloys; Bronchial Fistula; Bronchoscopy; Device Removal; Feasibility Studies; Female; Humans; Male; Middle Aged; Pleural Diseases; Pneumonectomy; Prosthesis Design; Radiography; Reoperation; Respiratory Tract Fistula; Rome; Stents; Time Factors; Treatment Outcome