[Approach to bronchopleural fistula in patients undergoing lung cancer surgery. A prospective study]. / Abordaje de la fístula broncopleural en pacientes intervenidos de cáncer de pulmón. Estudio prospectivo.

Twenty-four cases of bronchopleural fistula were found by fiberoptic bronchoscopy performed in 526 consecutive patients undergoing surgery for diagnosis or treatment of lung cancer between February 1990 and January 1997 in Hospital General Universitario in Valencia (Spain). In 327 of the patients lung resection was performed. Clinical symptoms included fever, purulent or bloodstained expectoration, chest pain, dyspnea and general unfitness, with 83.33% of the patients having pleural empyema. Treatment was based on pleural drainage and broad-spectrum antibiotic therapy, along with planning of the appropriate surgery technique to each patient. Surgery consisted in re-thoracotomy and bronchial closure in early detection cases without evidence of infection (< 48 h); thoracostomy (Clagett) and second stage myoplasty if confirmed pleural infection; thoracoplasty in cases of incomplete fistulas that were unresolved by pleural drainage. Biological glues were delivered by fiberoptic bronchoscope in one patient. The incidence of bronchopleural fistula was studied, as were associated factors and the results obtained by various surgical techniques.

[Congenital tracheoesophageal fistula in a 15-year-old male]. / Fístula traqueoesofágica congénita en un varón de 15 años.

We report a case of a 15-years-old boy with presumably congenital tracheoesophageal (H type) fistula. He has a history of recurrent bronchitis, bronchopneumonia and cough after liquid swallowing. Soon after an episode of blood stained sputum, a tracheal orifice in the pars membranacea that opened into the esophagus was found by fiberoptic bronchoscopy study. Chest and abdominal X-rays showed esophageal air and abdominal distention, respectively. The esophagram showed the passage of contrast agent to the tracheobronchial tree and no additional concurrent lesions. Cervical and thoracic magnetic resonance images revealed the location, morphology and anatomical relation to the neighbouring structures of the tracheoesophageal fistula, which was repaired surgically by left lateral cervicotomy and direct section and suture. The posterior wall of the trachea was reinforced with a muscle flap, with good results.