Bronchoscopic spigot occlusion of tuberculosis-associated bronchopleural fistula in a human immunodeficiency virus-positive high-risk patient

A bronchopleural fistula (BPF) is defined as an abnormal communication between an airway and the pleural space. This often can arise from complications after thoracic surgical interventions or from severe cavitating lung infections such as tuberculosis (TB). Management of BPF usually involves surgical repair through video-assisted thoracoscopy; however, this can be challenging in high-risk patients who are unsuitable for surgery. Bronchoscopic interventions are effective treatment options in patients who are unsuitable for surgery and involve the placement of valves, glues, coils, or spigots to seal the leaking bronchus. This case describes a successful BPF closure in a high-risk human immunodeficiency virus-positive patient with gastric malignancy who sustained a fistula as a result of cavitatory pulmonary TB. The procedure was done using the endobronchial Watanabe spigot, which is a cost-effective option for low-income countries. This procedure, done for the 1 st time in Kenya, underscores advancements in Kenyan interventional pulmonology, offering promising outcomes in the management of BPF, in the developing interventional pulmonology sector in Kenya.