Fistula of the Stump: A Novel Approach With a “stapled” Stent

Summary: Postoperative bronchopleural fistulas are serious and uncommon complications after pneumonectomy. Available therapeutic approaches are medical, endoscopic, and/or surgical. A 42-year-old man underwent left pneumonectomy. Three years later he was admitted to an intensive care unit with pneumonia of the remaining lung, severe respiratory insufficiency, and a bronchopleural fistula with an air fluid level filling in the pneumonectomy cavity. A left chest drain was placed, and broad-spectrum antibiotics and mechanical ventilation were administered. Because of the unstable clinical condition, a blind end endobronchial stent closed by a stapler was placed in the left bronchial stump. He improved in a couple of months and underwent definitive surgical sealing of the fistula. Summary: Endoscopic interventions are usually safe and free from associated complications. They are an excellent option, when patient’s clinical condition is contraindication to immediate surgery.