Lung torsion after tracheoesophageal fistula repair in an infant

Abstract

Lung torsion is a very rare event that has been reported in only 9 cases in the pediatric literature but has not yet been reported in Korean infants. We present a case of lung torsion after tracheoesophageal fistula repair in an infant. Bloody secretion from the endotracheal tube and chest radiographs and computed tomographic scan results indicated lung torsion. Emergency exploration indicated 180° torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion of both lobes, some improvement in the RUL color was observed, but the color change in the RML could not be determined. Although viability of the RML could not be proven, pexy was performed for both the lobes. Despite reoperation, clinical signs and symptoms did not improve. The bronchoscopy revealed a patent airway in the RUL but not in the RML. Finally, the RML was surgically removed. The patient was discharged on the 42nd day after birth.

Long‐term survival after treatment of idiopathic lung lobe torsion in 80 cases

“…The treatment of LLT is surgical, with lung lobectomy considered the gold standard in animals, whereas controversy still exits regarding the optimal treatment in human medicine. Resection of the nonviable tissue avoiding a reperfusion insult is the typical treatment in both dogs and human patients, but repositioning, with or without pexy, seems to represent a feasible option according to the findings in some studies in man . Mortality associated with LLT in human patients ranges from 8.3% to 16% .…”

“…Resection of the nonviable tissue avoiding a reperfusion insult is the typical treatment in both dogs and human patients, but repositioning, with or without pexy, seems to represent a feasible option according to the findings in some studies in man . Mortality associated with LLT in human patients ranges from 8.3% to 16% . Reported mortality rate in dogs ranges from 31% to 61%; however, more recent reports described a lower rate ranging from 8% to 14% …”

Pulmonary Torsion as an Atypical Complication of Congenital Esophageal Atresia Repair—A Case Report and Review of Literature

“… 1 6 Detorsion of a lung or a lobe of doubtful viability is controversial, as it may be connected with release of inflammatory mediators and necrotic tissue, leading to a systemic response and multiorgan failure. 1 13 14 In the two described cases of detorsion, one patient recovered completely, 1 whereas in the second case the lung remained shrunken and nonfunctioning. 6 In this case, detorsion allowed for better assessment of the lobe viability, and decrease in edema and hemostasis were observed.…”