Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post‐tuberculosis bronchiectasis

Abstract

We report a case of a persistent bronchopleural fistula following a pneumonectomy for post-tuberculosis bronchiectasis. The patient had two unsuccessful surgical attempts at closing of the fistula. Further surgical attempts were technically were not possible. Bronchoscopic closure was achieved by injecting human fibrin glue into the fistula via a catheter. Closure of the broncho-pleural fistula was confirmed by repeated ventilation scan over a period of 2 months. Endoscopic closure of small bronchopleural fistulae is an attractive option in children with significant underlying lung disease.

ERS statement: interventional bronchoscopy in children

“…Flexible bronchoscopy has been used to confirm and/or treat persistent BPF [157,158]. When a BPF is not clearly visible on bronchoscopy, selective bronchography at the suspected site may be utilised [159].…”

Use of Fibrin Sealant Glue as a Treatment for Massive Hemoptysis

“…The use of fibrin sealant glue has been described in neurosurgery, 4 ophthalmic surgery, 5 surgeries involving liver and kidney, 6 and in the closure of bronco-pleural fistulas. 7 The fibrin sealant is administered by an assembly that includes 2 syringes and an administration catheter (Fig.…”

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

“…Initially all the interventions were performed via the rigid bronchoscope but recently as larger working channels in fibre-optic bronchoscopes became available the more procedures are performed via the flexible bronchoscope 3,24 . Common interventions performed in children via the flexible bronchoscope include removal of foreign bodies and mucus plugs, endobronchial and transbronchial needle aspiration biopsies, assistance with endotracheal intubation including selective intubation, lung lavage for alveolar proteinosis, selective placement of endobronchial catheters, airway dilatation and for the sealing of trachea-bronchial fistula using fibrin glue [3][4][5] . The number of intervention on children performed globally is unknown and effectiveness of these interventions is uncertain as no randomised control trials have been performed.…”

“…3 Interventional bronchoscopy has resulted in new procedures such as the sealing of trachea-oesophageal fistulas, bronchooesophageal fistulas and post pneumonectomy stump leaks in children [3][4][5] . The vast majority of publications on bronchoscopy are from high income countries such as the United States, Europe and Israel [6][7][8][9] .…”