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In a 71-year-old man, BPF developed after left upper lobectomy in the setting of steroid-treated acute exacerbation of interstitial pneumonia. CT and bronchoscopy showed complete bronchial stump dehiscence with a 10-mm defect without infection. Elective surgery 6 months later used bronchoscopic guidance for retrograde insertion and suturing of a pedicled latissimus dorsi flap into the bronchus. Follow-up CT and bronchoscopy at 3 and 6 months confirmed complete closure and healing.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/retrograde-intrabronchial-suturing-of-a-latissimus-dorsi-flap-for-the-surgical-repair-of-bronchopleural-fistula-a-case-report/458829/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/retrograde-intrabronchial-suturing-of-a-latissimus-dorsi-flap-for-the-surgical-repair-of-bronchopleural-fistula-a-case-report/458829.png","ImageObject",300,407,{"name":92,"@type":93},"Alexandar","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is bronchopleural fistula (BPF) in this case, and why is it significant?","Question",{"text":112,"@type":113},"BPF is a rare but serious postoperative complication after lung surgery. In this report, it occurred after left upper lobectomy and involved complete bronchial stump dehiscence.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the BPF evaluated before definitive treatment?",{"text":117,"@type":113},"CT and bronchoscopy identified complete bronchial stump dehiscence with a 10-mm defect. Infection was not present, guiding the decision for elective surgery.",{"name":119,"@type":110,"acceptedAnswer":120},"What technique was used to close the BPF?",{"text":121,"@type":113},"A pedicled latissimus dorsi muscle flap was retrogradely inserted and sutured into the bronchus using bronchoscopic guidance. Fibrin glue was applied around the repair site for reinforcement.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},458829,1790754549,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":52,"preview_page_count":4},962090768658,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Journal of Surgical Case Reports, 2026, 1, rjaf1057  \n[https://doi.org/10.1093/jscr/rjaf1057](https://doi.org/10.1093/jscr/rjaf1057)  \nCase Report  \nCase Report  \nRetrograde intrabronchial suturing of a latissimus dorsi flap for the surgical repair of bronchopleural fistula: a case report  \nAkifumi Nakamura*, Nobuyuki Kondo, Masaki Hashimoto, Soichiro Funaki  \nDivision of Thoracic Surgery, Department of Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan  \n*Corresponding author. Division of Thoracic Surgery, Department of Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.  \nE-mail: [xxmp97511@zeus.eonet.ne.jp](xxmp97511@zeus.eonet.ne.jp)  \nAbstract  \nBronchopleural fistula (BPF) is a rare but serious postoperative complication after lung surgery. While secondary procedures are often required, primary closure with autologous tissue may be feasible in selected cases. A 71-year-old man developed a large BPF after left upper lobectomy, associated with steroid-treated acute exacerbation of interstitial pneumonia. Computed tomography (CT) and bronchoscopy revealed complete bronchial stump dehiscence with a 10-mm defect. As no infection was present, elective surgery was performed 6 months later. Using bronchoscopic guidance, a pedicled latissimus dorsi muscle flap was retrogradely inserted and sutured into the bronchus. The postoperative course was uncomplicated, and CT and bronchoscopy at 3 and 6 months confirmed complete closure and healing. Retrograde bronchial filling using a latissimus dorsi flap with bronchoscopic assistance achieved successful closure of a large, non-infected chronic BPF and may be a useful option in selected patients.  \nKeywords: bronchopleural fistula; latissimus dorsi flap; intrabronchial  \nIntroduction  \nBronchopleural fistula (BPF) is a serious postoperative complication following lung surgery [1] . Management strategies for BPF depend on the patient’s overall condition, the presence of infection, the size and location of the fistula, and the timing of its onset [2 , 3] . We present a case of a large, non-infected BPF successfully treated by retrograde bronchial filling using a pedicled latissimusdorsi flap.  \nCase report  \nA 71-year-old man undergoing steroid therapy for rheumatoid arthritis was admitted to our hospital. A follow-up chest radiograph revealed an abnormal shadow, and computed tomography (CT) subsequently identified a solid tumor (maximum diameter, 1.9 cm) in the left upper lobe. A transbronchial biopsy confirmed squamous cell carcinoma, leading to a clinical diagnosis of lung squamous cell carcinoma (c-T1bN0M0, stage IA2) . The patient underwent video-assisted thoracoscopic left upper lobectomy. Owing to a severely incomplete fissure, a bronchial-first approach was adopted. The operation lasted 103 min with an estimated blood loss of 10 mL. Postoperatively, the patient experienced an acute exacerbation of interstitial pneumonia, which was managed with a steroid pulse followed by prednisolone. He was  \ndischarged 1 month after surgery on home oxygen therapy, with his prednisolone dose gradually tapered during follow-up. Final pathology revealed adenosquamous carcinoma (p-T1bN0M0) .  \nAt 1 month postoperatively, CT imaging revealed a small airspace adjacent to the upper lobe bronchial stump (Fig. 1A) . In the absence of infection, conservative observation was chosen. Despite the patient remaining asymptomatic, subsequent CT scans at 3 and 6 months demonstrated gradual enlargement of the air space (Fig. 1B and C) . Bronchoscopic evaluation showed failure of the staple line at the upper division bronchus (B1 + 2, B3) near the bronchial stump, resulting in a complete separation of ∼10 mm with surrounding whitish changes (Fig. 1D and E) . An infection-free upper lobe BPF was diagnosed, and a one-stage closure using a latissimus dorsi flap was planned.  \nAfter harvesting the latissimus dorsi flap through a posterolateral in","cbCaiu3Vw32mumim","https://ap.wps.com/l/cbCaiu3Vw32mumim","pdf",662362,"English","# Introduction\n# Case report\n## Surgical planning and postoperative course\n## Follow-up imaging and diagnosis\n## Operative technique using bronchoscopic guidance\n## Reinforcement and outcomes","[{\"question\":\"What is bronchopleural fistula (BPF) in this case, and why is it significant?\",\"answer\":\"BPF is a rare but serious postoperative complication after lung surgery. In this report, it occurred after left upper lobectomy and involved complete bronchial stump dehiscence.\"},{\"question\":\"How was the BPF evaluated before definitive treatment?\",\"answer\":\"CT and bronchoscopy identified complete bronchial stump dehiscence with a 10-mm defect. Infection was not present, guiding the decision for elective surgery.\"},{\"question\":\"What technique was used to close the BPF?\",\"answer\":\"A pedicled latissimus dorsi muscle flap was retrogradely inserted and sutured into the bronchus using bronchoscopic guidance. Fibrin glue was applied around the repair site for reinforcement.\"}]","Retrograde intrabronchial suturing of a latissimus dorsi flap for the surgical repair of bronchopleural fistula - a case report | PDF"]