Retrograde intrabronchial suturing of a latissimus dorsi flap for the surgical repair of bronchopleural fistula: a case report

Bronchopleural fistula (BPF) is a rare but serious postoperative complication after lung surgery. While secondary procedures are often required, primary closure with autologous tissue may be feasible in selected cases. A 71-year-old man developed a large BPF after left upper lobectomy, associated with steroid-treated acute exacerbation of interstitial pneumonia. Computed tomography (CT) and bronchoscopy revealed complete bronchial stump dehiscence with a 10-mm defect. As no infection was present, elective surgery was performed 6 months later. Using bronchoscopic guidance, a pedicled latissimus dorsi muscle flap was retrogradely inserted and sutured into the bronchus. The postoperative course was uncomplicated, and CT and bronchoscopy at 3 and 6 months confirmed complete closure and healing. Retrograde bronchial filling using a latissimus dorsi flap with bronchoscopic assistance achieved successful closure of a large, non-infected chronic BPF and may be a useful option in selected patients.