Post-pneumonectomy bronchopleural fistula: complex surgical repair for a high mortality case

Post-pneumonectomy empyema and bronchopleural fistula are dreaded complications of thoracic surgery. The associated mortality and morbidity is very high. When treatment is delayed secondary complications are more likely and survival is adversely affected. These conditions require early diagnosis and a wellplanned multi-disciplinary team approach for effective management. We present a patient with post-pneumonectomy empyema and bronchopleural fistula following pneumonectomy for post tuberculosis destroyed lung. He underwent debridement of the empyema cavity, double layer closure of the bronchial stump and reinforcement with omental flap and pectoralis major flap was used to obliterate the space. Debridement and pedicle flaps are safe and effective in the definitive management of postpneumonectomy empyema and bronchopleural fistulae.