Post traumatic persistent broncho-pleural fistula managed with autologous blood patch pleurodesis: a rare case report

Rohit Dutta; Deepak Gehlaut; Rakesh K. Jha

doi:10.18203/2349-2902.isj20262487

Authors

Rohit Dutta Department of Cardiothoracic Surgery, Institute of Naval Medicine INHS Asvini, Mumbai, Maharashtra, India
Deepak Gehlaut Department of Cardiothoracic Surgery, Institute of Naval Medicine INHS Asvini, Mumbai, Maharashtra, India
Rakesh K. Jha Department of Cardiothoracic Surgery, Institute of Naval Medicine INHS Asvini, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20262487

Keywords:

Autologous blood patch pleurodesis, Hemopatch, Bronchopleural fistula, Pneumothorax, Intercostal drainage

Abstract

Persistent air leak (PAL) and bronchopleural fistula (BPF) following penetrating thoracic trauma are uncommon and pose significant therapeutic challenges. Surgical repair and endoscopic interventions may not always be feasible, particularly in peripheral fistulas or in hemodynamically fragile patients. We report a rare case of post-traumatic persistent BPF following a close-range firearm injury to the chest in a 26-year-old male. Despite initial stabilization and intercostal drainage, the patient developed recurrent pneumothorax with massive air leak after chest tube removal. Imaging confirmed a BPF. Autologous blood patch pleurodesis (ABPP) was performed via the intercostal drain using 100 mL of autologous blood. A repeat instillation was required after 24 hours due to PAL, following which complete resolution was achieved. The lung remained fully expanded, and the chest tube was successfully removed without complications. This case highlights ABPP as a simple, safe, cost-effective, and minimally invasive option for managing refractory post-traumatic PAL when conventional measures fail.

References

Yoo A, Ghosh SK, Danker W, Kassis E, Kalsekar I. Burden of air leak complications in thoracic surgery estimated using a national hospital billing database. Clin Outcomes Res. 2017;9:373-83.

Jabłonski S, Kordiak J, Wcisło S, Terlecki A, Misiak P, Santorek Strumiłło E, et al. Outcome of pleurodesis using different agents in management prolonged air leakage following lung resection. Clin Respir J. 2018;12:183-92.

Travaline JM, McKenna RJ Jr, De Giacomo T, Venuta F, Hazelrigg SR, Boomer M, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009;136:355-60.

Stamenovic D, Messerschmidt A, Steger V, Schneider T. New method in treatment of post-operative air leakage with fresh frozen plasma. ANZ J Surg. 2020;90:144-9.

Robinson CL. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg. 1987;30:428-9.

Rinaldi S, Felton T, Bentley A. Blood pleurodesis for the medical management of pneumothorax. Thorax. 2009;64:258-60.

Dumire R, Crabbe MM, Mappin FG, Fontenelle LJ. Autologous ‘blood patch’ pleurodesis for persistent pulmonary air leak. Chest 1992;101:64-6.

Andreetti C, Venuta F, Anile M, De Giacomo T, Diso D, Di Stasio M, et al. Pleurodesis with an autologous blood patch to prevent persistent air leaks after lobectomy. J Thorac Cardiovasc Surg. 2007;133(3):759-62.

Shackcloth MJ, Poullis M, Jackson M, Soorae A, Page RD. Intrapleural instillation of autologous blood in the treatment of prolonged air leak after lobectomy: a prospective randomized controlled trial. Ann Thorac Surg 2006;82:1052-6.

Lang-Lazdunski L, Coonar AS. A prospective study of autologous “blood patch” pleurodesis for persistent air leak after pulmonary resection. Eur J Cardiothorac Surg. 2004;26:897-900.

Oliveira FH, Cataneo DC, Ruiz RL Jr, Cataneo AJ. Persistent pleuropulmonary air leak treated with autologous blood: results from a university hospital and review of literature. Respiration. 2010;79(4):302-6.

Ploenes T, Kyritsis I, Mardanzai K, Muhmann D, Langehegermann L, Slama A, et al. A Prospective Study Investigating Blood Patch Pleurodesis for Postoperative Air Leaks After Pulmonary Resection. J Surg Res. 2020;255:240-6.

Campisi A, Dell'Amore A, Zhang Y, Angelo PC, Eleonora F, et al. Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood? Thorac Cardiovasc Surg. 2021;70(8):671-6.

Cagirici U, Sahin B, Cakan A, Kayabas H, Buduneli T. Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. Scand Cardiovasc J. 1998;32:75-8.

Droghetti A, Schiavini A, Muriana P, Comel A, De Donno G, Beccaria M, et al. Autologous blood patch in persistent air leaks after pulmonary resection. J Thorac Cardiovasc Surg. 2006;132(3):556-9.

Wan YY, Zhai CC, Lin XS. Safety and complications of medical thoracoscopy in the management of pleural diseases. BMC Pulm Med. 2019;19(1):125.