[The use of an omental pedicle flap in the closure of a wide bronchial fistula after pneumonectomy: a case report].

A 52-years-old man with pulmonary hypofunction had a squamous cell lung carcinoma and underwent the right upper lobectomy. Bronchial fistula with lung abscess developed on the 6th post-operative day. So, the right middle and lower lobectomy (completion pneumonectomy) were done. But, bronchial fistula again appeared at the time of weaning from respirator. It increased in size to about 4.0 x 2.0 cm. Then, transposition of an omental pedicle flap for closure on a wide bronchial fistula, and muscular plombage and thoracoplasty for semifilling up a secondary empyema cavity were performed. On bronchoscopy performed 14 days after operation, the fistula was completely closed, and the transposed omentum did not project into the trachea. We accomplished our first aim to close the wide bronchial fistula with omentum. However, he died 59 days after the 3rd operation because we failed to control infection of the remaining empyema cavity of about 100 ml. The management of an empyema cavity remains to be a difficult therapeutic problem.