RSS-Feed abonnieren
DOI: 10.1055/s-0032-1311551
Surgical Therapy for Necrotizing Pneumonia and Lung Gangrene
Publikationsverlauf
22. Dezember 2011
27. Februar 2012
Publikationsdatum:
03. Oktober 2012 (online)
![](https://www.thieme-connect.de/media/thoracic/201307/lookinside/thumbnails/10.1055-s-0032-1311551-1.jpg)
Abstract
Objective Necrotizing pneumonia, pulmonary abscess, and lung gangrene are rare complications of severe pulmonary infection with devitalization and sloughing of lung tissue. Pulmonary necrosis is often associated with alcoholism and other chronic disorders with known immunodeficiency. Mortality is significant and both treatment strategies as well as the role of surgery are controversially debated.
Methods In a retrospective review at a German tertiary referral hospital, 20 patients with pulmonary resection for necrotizing lung disorders were identified since 2008. At hospital admission, all patients suffered from pulmonary sepsis and despite adequate medical treatment progressing parenchymal destruction and devitalization took place. The majority of the patients sustained pleural empyema (13/20) and five patients a persisting air leak. On account of failing medical therapy, eight patients (40%) developed severe sepsis with septic shock and four patients (20%) were already preoperatively ventilated. Chronic alcoholism was present in 10 patients (50%).
Results Gangrene of a complete lung was seen in four cases. Lobar gangrene or necrotizing pneumonia complicated by fulminate abscess was seen in the right lower lobe (8/20), middle lobe (4/20), right upper lobe (2/20), and left lower lobe (2/20). Procedures included pneumectomy (4/20), lobectomy (13/20), and limited resection (3/20). The bronchial stump was reinforced with a pedicle muscle flap in seven cases. There were three postoperative deaths due to septic shock with multiorgan failure. The remaining 17 patients (85%) recovered well and were transferred to rehabilitation clinics specialized on pulmonary disorders.
Conclusion Necrotizing pulmonary infections are infrequent but are life-threatening disease entities. Patients often present with severe comorbidity and chronic disorders causing immunodeficiency. If initial medical therapy fails surgery offers a reasonable therapeutic approach. Aim of surgical therapy is resection of all gangrenous lung parenchyma and effective drainage of pleural empyema. Then recovery is feasible in up to 80%.
Note
Presented at the Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain & Ireland (ACTA/SCTS annual meeting & cardiothoracic forum—Manchester18th to 20th April, 2012).
-
References
- 1 Penner C, Maycher B, Long R. Pulmonary gangrene. A complication of bacterial pneumonia. Chest 1994; 105 (2) 567-573
- 2 Reimel BA, Krishnadasen B, Cuschieri J, Klein MB, Gross J, Karmy-Jones R. Surgical management of acute necrotizing lung infections. Can Respir J 2006; 13 (7) 369-373
- 3 Neuhof H, Hurwitt E. Acute putrid abscess of the lung: VII. Relationship of the technic of the one-stage operation to results. Ann Surg 1943; 118 (4) 656-664
- 4 Schweppe HI, Knowles JH, Kane L. Lung abscess. An analysis of the Massachusets General Hospital cases from 1943 through 1956. N Engl J Med 1961; 265 (21) 1039-1043
- 5 Hagan JL, Hardy JD. Lung abscess revisited. A survey of 184 cases. Ann Surg 1983; 197 (6) 755-762
- 6 Postma MH, le Roux BT. The place of external drainage in the management of lung abscess. S Afr J Surg 1986; 24 (4) 156-158
- 7 Shaw RR, Paulson DL. Pulmonary resection for chronic abscess of the lung. J Thorac Surg 1948; 17 (4) 514-522
- 8 Waterman DH, Domm SE. Changing trends in the treatment of lung abscess. Dis Chest 1954; 25 (1) 40-53
- 9 Chen CH, Huang WC, Chen TY, Hung TT, Liu HC, Chen CH. Massive necrotizing pneumonia with pulmonary gangrene. Ann Thorac Surg 2009; 87 (1) 310-311
- 10 Shaw RR. Pulmonary abscess: value of early one-stage drainage. J Thorac Surg 1942; 11: 453-466
- 11 Refaely Y, Weissberg D. Gangrene of the lung: treatment in two stages. Ann Thorac Surg 1997; 64 (4) 970-973 , discussion 973–974
- 12 Stivelman BP, Kavee J. Penicillin in the treatment of putrid lung abscess. Ann Intern Med 1946; 25: 66-77
- 13 Stivelman BP, Kavee J. The treatment of acute putrid lung abscess with penicillin and sulfadiazine. Ann Intern Med 1949; 30 (2) 343-363
- 14 Myers RT, Bradshaw HH. Conservative resection of chronic lung abscess. Ann Surg 1950; 131 (6) 985-993
- 15 Krishnadasan B, Sherbin VL, Vallières E, Karmy-Jones R. Surgical management of lung gangrene. Can Respir J 2000; 7 (5) 401-404
- 16 Tsai YF, Tsai YT, Ku YH. Surgical treatment of 26 patients with necrotizing pneumonia. Eur Surg Res 2011; 47 (1) 13-18
- 17 Schweigert M, Kraus D, Ficker JH, Stein HJ. Closure of persisting air leaks in patients with severe pleural empyema—use of endoscopic one-way endobronchial valve. Eur J Cardiothorac Surg 2011; 39 (3) 401-403