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Operative findings showing chest tube (arrows) stabbing the right upper lobe toward the apical portion, which has not completely penetrated through the lung but has extended to just under the visceral pleura
Source publication
Background
Pulmonary tractotomy effectively treats deep pulmonary penetrating injuries; however, it requires the accurate insertion of forceps or a stapler into the wound tract. This report describes a case of tractotomy using the Penrose drain guide for a deep lung injury caused by chest drainage.
Case presentation
A 75-year-old man suffered mult...
Context in source publication
Context 1
... 1 Department of Thoracic Surgery, Okazaki City Hospital, 3-1 Gosyoai, Koryuji-cho, Okazaki, Aichi 444-8553, Japan Full list of author information is available at the end of the article and bleeding into the respiratory tract. The chest tube partially protruded into the right upper lobe toward the apical portion, just under the visceral pleura (Fig. 2). However, cutting the visceral pleura covering the chest tube's tip caused the tube to fully penetrate the lung. A Penrose drain tube (outer diameter: Φ6.0 mm) was fixed to the chest tube, which was then removed. The Penrose drain tube fully penetrated the lung and was coupled to the anvil side of the stapler to guide the stapler ...
Citations
Iatrogenic lung injury caused by chest tube insertion is a potential complication that requires careful attention, and thoracic surgeons should be knowledgeable about the appropriate management strategies if complications arise. This report describes a successful procedure for treating an iatrogenic lung injury. An 80-year-old Japanese man with severe emphysema complaining of breathlessness was diagnosed with a right secondary pneumothorax. Computed tomography revealed moderate adhesions in the thoracic cavity. Chest tube drainage was performed. Lung expansion was insufficient and massive air leakage continued. Repeat computed tomography showed the chest tube inserted into the right upper lobe. Thus, pulmonary tractotomy followed by free fat pad coverage was performed to successfully treat the iatrogenic lung injury caused by chest tube insertion. Since no air leakage was observed postoperatively, the chest tube was removed on the third postoperative day. The patient was discharged after two weeks of rehabilitation. Pulmonary tractotomy combined with free subcutaneous fat pad coverage would be effective for repairing iatrogenic lung injuries in patients with severe emphysema.
The patient was a 77-year-old male who had attended our hospital for combined pulmonary fibrosis and emphysema. He was diagnosed with left pneumothorax by chest radiograph with a chief complaint of exertional dyspnea after cough. Thoracic drainage was initiated, and slight air leakage was identified only on exertion. On the seventh day, a chest radiograph revealed an infiltrative shadow in the right upper lung field, and chest computed tomography revealed consolidation in the right upper lobe of the lung and a thoracic drain in the left upper lobe of the lung. However, the patient showed respiratory failure due to concurrent pneumonia; hence, we decided to improve his respiratory condition while the drain was in place. The thoracic drain was removed under general anesthesia on the 28th day. Intraoperative findings revealed a fistula at the lung puncture site due to the thoracic drain; however, there was no evidence of air leakage or bleeding from the site. The patient was discharged on postoperative day 43.
Lung injury caused by the placement of a thoracic drain is often treated with emergency surgery, but elective surgery, as in this case, is rare. It is thus suggested that elective thoracic drain removal should be a treatment option if the patient's respiratory condition is unstable but the pneumothorax is under control.
