Successful Treatment of Obstructive Pneumonia with Hemoptysis due to Non-Absorbable Suture-Related Granulation

TL;DR

A man developed obstructive pneumonia and hemoptysis due to a non-absorbable suture from a past surgery, which was successfully treated with surgery and stent removal.

Contribution

This case is the first to report curative surgical excision for suture-related granulation tissue causing bronchial obstruction.

Findings

Non-absorbable sutures can cause delayed granulation tissue leading to bronchial obstruction and hemoptysis.

Curative surgical excision, including stent and suture removal, resolved the complications in this case.

Absorbable sutures are recommended for bronchial stump protection to avoid such long-term complications.

Abstract

Non-absorbable sutures or Teflon pledgets (model number: 00801741041341, Bard, Franklin Lakes, NJ, USA) are sometimes used for protection of the bronchial stump to prevent bronchial fistula. However, there have been reports of foreign body-related bronchial granulation in the distant phase. Treatment of this rare complication is challenging, and there are no reports in the literature of cases that ultimately underwent curative surgical excision.

A 63-year-old man underwent a right lower lobectomy with ND2a-2 for typical pulmonary carcinoid 20 years ago. Twelve years after the operation, the right intermediate bronchus gradually became obstructed with granulation tissue from the right lower bronchial stump. Therefore, we eliminated the obstruction and placed a 2-cm Dumon stent (model number: 20300BZY00250000, Novatech SA, La Ciotat, France) in the intermediate bronchus. However, the inner lumen of the stent gradually became filled with the granulation tissue, and 6 years after the stenting, the patient was referred to the hospital owing to massive hemoptysis and obstructive pneumonia. Although transcatheter bronchial arterial embolization was performed for a pseudoaneurysm, blood-tinged sputum remained present, and aspiration pneumonia had spread to the right upper lobe. Bronchoscopy showed that a non-absorbable suture, which was used for the protection of the bronchial stump 20 years ago, was buried in the obstructive tissue. After antibiotic treatment for the pneumonia, we performed a right middle lobectomy as well as the removal of the stent and the threads as a curative treatment.

Non-absorbable suture sometimes causes granulation tissue in the distant phase, and absorbable sutures are preferable for the bronchial stump. For the treatment, complete excision at an appropriate time is required based on the severity of the symptoms.

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