Bronchopleural fistula after stapled closure of bronchus.

The incidence of bronchopleural fistula after stapling among 2,243 pulmonary resections at the Rush-Presbyterian-St. Luke's Medical Center has been reviewed. There were 35 fistulas in 1,773 stapled and in 470 sutured bronchi (segmentectomy, 2; lobectomy, 1; bilobectomy, 9; and pneumonectomy, 23). We have found that the stapler is expedient and simple to use, and that it produces a hermetic and uniform closure. The stapler is contraindicated when the bronchus is thickened, inflamed, or of insufficient length. The overall incidence of bronchopleural fistula was 1.6%. Approximately two thirds of the patients with bronchopleural fistula had preoperative radiation therapy or chemotherapy or both.

Tracheoplasty for congenital complete tracheal rings.

OBJECTIVE: To better appreciate the complex nature of the pediatric patient with tracheal stenosis due to congenital complete tracheal rings, we evaluated clinical presentation, methods of evaluation, necessity for surgical repair, associated anomalies, and outcome. DESIGN: Retrospective study. PATIENTS: Eighteen patients with long-segment tracheal stenosis due to congenital complete tracheal rings were evaluated at Cincinnati (Ohio) Children's Hospital Medical Center between 1985 and 1991. Three patients did not require surgical intervention. Fifteen patients underwent tracheoplasty with cardiopulmonary bypass through a midline sternotomy. RESULTS: The patients with congenital complete tracheal rings usually present with respiratory compromise in the first year of life. In the majority of patients, a diagnosis was made based on the symptoms and findings of an endoscopic examination with the aid of plain film roentgenography. In selected patients, computed tomography or magnetic resonance imaging was used. We evaluated symptoms, length of stenosis, type of repair, duration of intubation, and complications, as well as the mortality associated with this procedure. CONCLUSIONS: The technique of tracheoplasty has evolved at our institution, including the use of a posterior tracheal division, anterior castellated division, autologous pericardial patch grafting, and cricoid split with intubation for 7 to 21 days. We found the mortality associated with this procedure quite high at 47%, compared with previously published reports with mortality figures between zero and 77%.

Transvaginal injury of the duodenum, diaphragm, and lung.

An unusual case of transvaginal impalement is presented. At initial exploration the broad ligament and vagina were repaired. When bile drained from suction catheters reexploration revealed an injury to the duodenum and diaphragm. Wounds that penetrate the vagina may injure nonpelvic viscera. Vaginal penetrating wounds should be managed like other abdominal penetrating injuries.