Bronchial fistula

Bronchial fistula (fistula bronchialis) - pathological channel between the lumen of the bronchus and cavity in the lung, pleural cavity, any internal organ or the surface of the skin. Bronchial fistula can develop when penetrating wounds of the chest, after operations on the lungs, often partial resection, at least - after pneumonectomy. Most often they occur in patients operated on for purulent diseases of the lung.
The reason B. C. addition of infection may be the primary failure of the seams of bronchus stump due to errors in technique (significant trauma, unwanted, skeletization bronchus, incomplete sealing his stump, insufficient grasping at the seam back walls bronchus, too thick needle, excessive tightening of nodes and others). Doubtless important are also the peculiarities of the patient (the degree of reactivity and resilience, inflammatory-dystrophic changes bronchus and others).
Bronchial fistulas are divided into single and multiple; in each of these groups consists of broncho-skin, bronchopleural (Fig.), broncho-pulmonary and bronchial-organ fistula. There are also multiple, or "lattice", fistulas ("grid easy") with varying degrees of changes in lung parenchyma. Among postoperative B. C. prevail bronchopleural. Small group are bronchial fistulas, connected not only with the pleural cavity, but also with internal organs, for example with the esophagus. These leaks can result from unnoticed injury of the esophagus in the allocation of the lung (especially on the right).
At a time when there are acute postoperative bronchial fistulas, in which the failure of bronchus stump occurs within the first 48 hours after surgery; early manifested in the first 2 weeks, and later formed later.
Acute stump bronchopleural fistula clinically manifested as infected traumatic pneumothorax. The patient usually is in a difficult position: restless, complains and tightness chest pain; pale skin, covered with cold sweat, sometimes expressed subcutaneous emphysema. Temperature and hemogram point to an urgent development of a purulent infection. Shortness of breath, surface and fast; the pulse frequent, weak filling. Dry cough, often expectoration rich wound exudate (pleural cavity), in the presence of drainage through it passes the air.
The clinical course of early stump bronchopleural fistula less turbulent, as the remaining parts of lungs has been partially dealt with the bronchus lumen reported a limited part of the pleural cavity, and pleura, covered by a fibrin, are less sensitive to irritation air. Clinical symptoms: fever, mild dizziness, peripheral blood changes, cough with mucopurulent or bloody sputum, sometimes with the release of the contents of the pleural cavity. When introduced into the pleural cavity of medicinal substances their taste and smell can be felt sick when exhaling. The emergence of early bronchial fistulas usually precede other pulmonary and pleural complications, pneumonia, pnevmofibros, collapse and lung atelectasis.
The development of late stump bronchopleural fistula often contributes to the aggravation of the dormant infection. There are signs of acute scurvy residual pleural cavity (fever, painful cough, chest pain, and others). During a coughing spell sometimes simultaneously otharkiwate large portions of liquid sputum brown. The intense largely depends on the size of the residual of the pleural cavity, the characteristics of microflora and other
The largest value in the recognition of bronchial fistulas has x-ray (see below). Convincing data for the diagnosis of bronchopleural fistula can be obtained by manometry pleural cavity; if the fistula it is registered positive pressure.

Direct bronchogram left after the lower left-hand lobectomy and prosthetics porolonovoj a sponge. Postoperative empyema of residual cavity and alveolar" bronchopleural fistula.