Incidental haemothorax after sublobar resection: did staple line scratch chest wall?

Abstract

We herein report a case of life-threatening haemothorax that occurred 40 days after pulmonary segmentectomy in a 60-year-old man. The patient uneventfully underwent resection of the apical and posterior segments of the right upper lobe by video-assisted thoracic surgery for early-stage lung cancer. An emergency operation of haemostat for active bleeding from the intercostal artery was successful via a right thoracotomy. The bleeding point was in the vicinity of the staple line dividing the intersegmental plane. This case reveals that scratch by staples can cause haemothorax through incidental injury of the intercostal artery.

An unexpected complication of videothoracoscopic lobectomy: late RIMA bleeding

“…The advantages include improved patient satisfaction due to less surgical trauma, less postoperative pain, faster recovery, and less invasiveness compared to open surgical techniques [ 2 ]. Endoscopic vascular and parenchymal staplers are widely used for video-assisted thoracic surgery (VATS) and are mostly considered a safe technique [ 3 ].…”

Commentary: Is there preventive measure for postoperative bleeding caused by the erosion of the bronchial staple-line in the chest wall?

“…With respiratory movement, the stump might rub against the thoracic vertebra, leading to rupture and bleeding of the intercostal artery. Negishi and colleagues 4 reported a life-threatening hemothorax that occurred 40 days after surgery. The bleeding was from the intercostal artery, whose point was in the vicinity of the staple line dividing the intersegmental plane.…”