Postoperative rupture of bronchial stump inducing severe hemorrhage from pulmonary artery trunk: a case report

Surgical resection constitutes the cornerstone of treatment for lung cancer, a disease with high global incidence. Among postoperative complications, delayed fatal hemorrhage occurring beyond 30 days postoperatively has garnered scant attention in clinical and research settings. Notably, there are no documented cases of vascular rupture and bleeding induced by chronic mechanical friction between the bronchial stump and pulmonary artery trunk to date. Following pulmonary lobectomy, the anatomical proximity between the bronchial stump and pulmonary artery trunk creates a potential risk of delayed pulmonary artery hemorrhage secondary to bronchial stump-related pathology. Herein, we report a case of a 53-year-old male patient who presented with sudden massive hemoptysis on the 40th day after right upper lobectomy. Bronchial artery embolization was initially performed but failed to control the bleeding. Emergency thoracotomy revealed a 3-mm rupture with active bleeding in the right pulmonary artery trunk, accompanied by a 2-mm fistula at the right upper lobe bronchial stump. Intraoperatively, the vascular rupture was repaired using a pericardial patch, and both the repaired vessel and the bronchial stump were wrapped with an intercostal muscle flap, achieving successful hemostasis. The patient experienced an uneventful postoperative recovery and remained alive and well at the 3-month follow-up. Written informed consent was obtained from the patient for the publication of this case report and the accompanying clinical images.