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Clinical Image
Combined Endoscopic Treatment for the Closure of a Large Bronchopleural Fistula
Tratamiento endoscópico combinado para el cierre de una fístula broncopleural de gran tamaño
María José Bernabé Barrios
Corresponding author
mariucha2002703@hotmail.com

Corresponding author.
, Roberto Larrosa Barrero, Elena Forcén Vicente de Vera
Servicio de Neumología, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our patient was a 74-year-old male&#44; operated 10 months previously for epidermoid carcinoma with a right bilobectomy &#40;middle lobe and right lower lobe&#41; with double thoracotomy&#46; Fifteen days after surgery&#44; the patient developed empyema&#44; with evidence of a fistula due to dehiscence of the bilobectomy suture&#44; which required 2 new interventions that did not achieve closure of the fistula&#46; A third surgery in this situation involved a high surgical risk and offered very little chance of success&#46; Since at that time the patient showed no signs of endobronchial infection and the fistula orifice measured<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm on endoscopy&#44; the placement of the largest commercially available intrabronchial valve &#40;9<span class="elsevierStyleHsp" style=""></span>mm&#41; was proposed&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Anchoring the device was very difficult and&#44; in addition&#44; there was a risk of complication with migration via the patient&#39;s thoracotomy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a and b&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">One month after the last attempt at surgical closure&#44; the valve was implanted into the fistula orifice under conscious sedation&#44; and correct positioning was confirmed by endoscopy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Fifteen days after the procedure&#44; an endoscopic revision was conducted&#44; showing that the occlusion was not complete&#44; so we decided to use endoscopy to instill 10<span class="elsevierStyleHsp" style=""></span>ml of platelet-rich plasma over the mucosa bordering the valve&#46; This prompted a fibrotic reaction &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>d&#41;&#44; which facilitated the complete closure of the fistula and the disappearance of the air leak in one week&#46;</p></span>"
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                            2 => "H&#46;J&#46; Lee"
                            3 => "D&#46; Feller-Kopman"
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                          "autores" => array:2 [
                            0 => "J&#46;S&#46; Kurman"
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ISSN: 03002896
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