Treatment of intractable bronchopleural fistula with a one-side-closed silicone stent using retrograde approach: A case report

A male patient (age: 85 -years) with lung cancer underwent basal segmentectomy. Subsequently, he underwent emergency open window thoracotomy for a bronchial stump fistula. The general and nutritional conditions of the patient improved; nevertheless, natural closure of the fistula did not occur. Therefore, the patient underwent fistula closure using an endobronchial Watanabe spigot, polyglycolic acid sheet and N-butyl-2-cyanoacrylate. Nine months later, the fistula had enlarged. The air leak was treated by applying pressure with gauze; however, this approach was not sufficiently effective, and the patient became unable to expectorate phlegm or speak. One side of a straight-type silicone stent with an outer diameter measuring 9mm was closed, and the stent was inserted into the fistula through the fenestration with the closed side at the tip. The L-sized endobronchial Watanabe spigot was placed into the lumen of the stent to reinforce it. Air leak from the fistula was significantly reduced, making breathing and expectoration easier. Retrograde closure of a bronchial fistula using a unilaterally closed silicon stent can be an effective treatment for large, refractory bronchial fistulas.