Complex surgical management of main bronchus stump failure: a case report highlighting treatment challenges and successful outcome

Background: Main bronchus stump failure, with mortality rates of up to 30%, is one of the most serious complications after pneumonectomy. At present, there are various surgical and endoscopic techniques for the treatment of this condition, the choice among which depends on when the failure occurred. Circular resection of the tracheal bifurcation is rarely performed to patients with tuberculosis. Case Description: A 28-year-old woman was admitted to the Surgical Department of the Regional Clinical Center of Phthisiopulmonology with fibrous-cavernous tuberculosis of the right lung with widespread resistance to mycobacterial drugs, bilateral lung infection, complicated by empyema. After the pleuropneumonectomy the recurrent bronchial fistula has occurred. The clinical case demonstrates the possible difficulties in surgical treatment of bronchopleural complications for such patients. In order to achieve final success, operations such as pleuropneumonectomy, thoracoplasty, and transsternal circular resection of the tracheal bifurcation were required. Conclusions: Patients with advanced fibrous-cavernous tuberculosis complicated by empyema and extensive drug resistance represent the group at highest risk for main bronchus stump failure after pneumonectomy. Circular resection of the tracheal bifurcation, despite the complexity of this operation, can be considered one of the successful methods of treatment for patients with main bronchus stump failure even with different complications. This operation may be the last chance to save the patient’s life when other methods have failed.