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A Journal on Surgery

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Chirurgia 2014 August;27(4):253-5

language: English

Effective use of free omental plombage in a case of intractable pyothorax following surgery for secondary lung cancer

Shimizu J. 1, Yoshida M. 2, Ohtake H. 3

1 Department of Surgery, Hokuriku Central Hospital, Oyabe, Japan;
2 Department of Surgery, National Hospital Organization Ishikawa Hospital, Kaga, Japan;
3 Department of Thoracic and Cardiovascular Surgery, New Heart Watanabe Institute, Tokyo, Japan


An 83-year-old woman underwent a middle and lower lobectomy for lung cancers in 2010. Her computed tomography in August 2012 showed enlargement of ground glass opacity in the remaining right upper lobe (RUL), and the patient underwent partial resection of the RUL in October. However, one week after surgery, the patient developed pyothorax with bronchopleural fistula and underwent open window thoracostomy in November. As the open window site was purified to some extent, the patient underwent free omental flap transfer to anastomose the right gastroepiploic artery and vein of the omental flap along with right axillary artery and vein in February 2013; this resulted in healing of the intractable pyothorax with bronchopleural fistula. In patients with pyothorax and bronchopleural fistula, pedicled omental flap transfer should be considered. However, when the infection is in the upper thoracic cavity, free omental flap transfer combined with vascular anastomosis is useful for maximizing the use of the limited omental flap, providing favorable results.

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