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Lung necrosectomy in pediatric patients with necrotizing pneumonia

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Abstract

Introduction

Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy.

Methods

Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication.

Results

Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5 ± 13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy + lung necrosectomy 1 (4.1%), and wedge resection + lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis.

Conclusions

Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, National Institute of Respiratory Diseases “Ismael Cosio Villegas”, México DF, Mexico

    Francina V. Bolaños-Morales, Emmanuel Peña Gómez-Portugal & Patricio J. Santillán-Doherty

  2. Department of Pediatric Cardio-Pneumology, National Institute of Respiratory Diseases “Ismael Cosio Villegas”, México DF, Mexico

    María E. Aguilar-Mena

  3. Lung Transplantation Research Unit, National Institute of Respiratory Diseases “Ismael Cosio Villegas”, México DF, Mexico

    Avelina Sotres-Vega & J. Alfredo Santibáñez-Salgado

  4. INER, Calzada de Tlalpan 4502, Col. Sección XVI., Tlalpan, 14080, México DF, Mexico

    Francina V. Bolaños-Morales

Authors
  1. Francina V. Bolaños-Morales
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  2. Emmanuel Peña Gómez-Portugal
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  3. María E. Aguilar-Mena
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  4. Patricio J. Santillán-Doherty
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  5. Avelina Sotres-Vega
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  6. J. Alfredo Santibáñez-Salgado
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Correspondence to Francina V. Bolaños-Morales.

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Conflict of interest

All listed authors qualify for authorship according to the following criteria: (1) conceived, planned, and performed the work leading to the report, or interpreted the evidence presented, or both; (2) written the report or reviewed successive versions and participated in the revision; (3) approved the final version. No part of the work described has been published before nor the work is under consideration for publication elsewhere.

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Bolaños-Morales, F.V., Gómez-Portugal, E.P., Aguilar-Mena, M.E. et al. Lung necrosectomy in pediatric patients with necrotizing pneumonia. Gen Thorac Cardiovasc Surg 66, 155–160 (2018). https://doi.org/10.1007/s11748-017-0862-1

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  • DOI: https://doi.org/10.1007/s11748-017-0862-1

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