CASE REPORT   

Chirurgia 2021 June;34(3):126-30

DOI: 10.23736/S0394-9508.20.05138-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Successful removal of malpositioned chest tube within the lung in a patient with chronic obstructive lung disease

Junzo SHIMIZU ¹ ✉, Makio MORIYA ¹, Tadashi KAMESUI ¹, Jumpei OKAMOTO ¹, Toshiro NAGAYOSHI ², Yuichiro MACHIDA ³, Takashi KOBATA ³, Koichiro KOBAYASHI ⁴

¹ Department of Chest Surgery, Hokuriku Central Hospital, Oyabe, Japan; ² Department of Radiology, Hokuriku Central Hospital, Oyabe, Japan; ³ Department of Chest Surgery, Himi Municipal Hospital, Himi, Japan; ⁴ Department of Chest Surgery, Toyama Red Cross Hospital, Toyama, Japan

The patient involved in this study was a 95-year-old man with chronic obstructive pulmonary disease (COPD). In another hospital, the patient underwent chest tube drainage for his right pneumothorax, and the tube was removed after stopping of air leak. After several days, he had a recurrence of right pneumothorax after coughing and developed subcutaneous emphysema. A chest tube was re-inserted through the anterior chest wall. Immediately after that the subcutaneous emphysema worsened and respirator discomfort developed, and he was emergently transferred to our hospital. Chest computed tomography (CT) showed incorrect placement of chest tube by 10 cm or more into the right upper lobe of the lung, for which emergency surgery was performed. After opening the thorax, it was found that the chest tube was placed into the right lung in the direction from S³ to the apex with a length of approximately 11 cm. There was severe emphysematous change; therefore, we considered that unnecessary lobectomy should be avoided to preserve the respiratory function. The chest tube was removed from the lung and the incorrect insertion site was sutured, and the surgery was completed after confirming the absence of air leak and bleeding. The postoperative course was favorable, and the patient was transferred back to previous hospital at day 10. Thereafter, he was discharged on home oxygen therapy (HOT). Iatrogenic lung injury caused by incorrect insertion of a chest tube can be treated conservatively if injury to the lung parenchyma is mild. However, in cases of deep lung injury, like in the present case, it is safe to remove the tube and determine whether it is possible to preserve the injured lung under direct vision through emergency surgery. When inserting a chest tube, it is important to confirm the presence or absence of adhesion near the site of tube insertion by CT.

KEY WORDS: Chest tubes; Lung injury; Pulmonary disease, chronic obstructive