Transient Interventional Bronchus Occlusion As A New Treatment Approach For Persistent Bronchopleural Fistula Complicating Necrotizing Pneumonia In Four Children

Introduction: Persistent bronchopleural fistula (BPFs) is a serious complication of necrotizing pneumonia. Application of thoracic drainages and surgery are the current treatment options. These procedures are associated with pain, immobility, long hospital stay and severe complications like bleedings or respiratory failure in some cases. We herein present 4 children with persistent bronchopleural fistula who were successfully treated by transient endobronchial occluder insertion. Cases We present 4 children (4-16 yrs) with persisting BPFs (31 to 41 days). All patients required repeated drainage systems. In 2 children, previous surgical interventions did not lead to remission. One patient required extracorporeal membrane oxygenation in addition to invasive ventilation. All patients underwent bronchoscopy with occlusion of the affected bronchi by using self-expanding Amplatzer vascular plugs of various sizes. Significant clinical improvement directly after intervention was observed in all cases. Drains were removed 2-8 days after occlusion and the children were discharged from hospital 7-26 days after intervention. 6-12 weeks after the first intervention occluders were removed without complications and without recurrence of pneumothorax. Conclusion: Transient endoscopic bronchus occlusion seems to be an efficient therapeutic option for persistent BPFs and might prevent long term morbidity, long hospital stay and secondary complications due invasive treatments like repeated drainage insertion and/or surgical procedures. Prospective clinical trials are needed to proof the safety and efficacy of this new method.