Abstract
Background Postoperative intrathoracic active bleeding is a serious complication after general
thoracic surgery. Yet, progressive chest wall bleeding caused by a bronchial stump
nail after lobectomy has rarely been reported. The purpose of this report was to review
the causes, surgical treatment, and prevention of progressive chest wall bleeding
caused by a bronchial stump nail in patients after lobectomy.
Methods Between January 2011 and February 2013, approximately 5,000 patients underwent lobectomies
for various thoracic diseases in the Department of Thoracic Surgery of Shanghai Pulmonary
Disease Hospital in China. Among the 5,000 patients, four required reexploration for
progressive postoperative chest wall bleeding caused by bronchial stump nails.
Results Staples were used without covers for the bronchial stumps in these patients. At the
time of reoperation, we noted that the main site of bleeding was the pleura corresponding
to the bronchial stump. The bleeding pleura sites were coagulated and sutured, and
complete hemostasis of the pleura was achieved. The nails on the staple that may have
caused the bleeding were removed. Then, muscle or hemostatic material was applied
to separate the bronchial stump and corresponding pleura.
Conclusions Performing surgery carefully and understanding the risk from bronchial stump nails
are keys to preventing progressive postoperative bleeding.
Keywords
reoperation - surgery - complications - thoracoscopy/VATS
