Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 740-744
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.740
Idiopathic colopleural fistula presenting with lung abscess and refractory empyema: A case report
Chun-Li Wang, Kung-Chuan Cheng
Chun-Li Wang, Kung-Chuan Cheng, Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Author contributions: Wang CL wrote the original draft; Cheng KC prepared the figures, edited the main text, and supervised the study. Both authors reviewed the manuscript.
Informed consent statement: We obtained the patient's written informed consent to disclose his case. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that his identity will be concealed.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: This case report complies with the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kung-Chuan Cheng, MD, Attending Doctor, Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong District, Kaohsiung 833, Taiwan. topguncheng@gmail.com
Received: January 7, 2023
Peer-review started: January 7, 2023
First decision: January 21, 2023
Revised: January 27, 2023
Accepted: March 21, 2023
Article in press: March 21, 2023
Published online: April 27, 2023
Processing time: 106 Days and 4.8 Hours
Abstract
BACKGROUND

Colopleural fistula is a rare condition, and only a limited number of cases have been reported. Here, we report a case of idiopathic colopleural fistula in an adult without any known predisposing factors. The patient presented with a lung abscess and refractory empyema and was successfully treated with surgical resection.

CASE SUMMARY

A 47-year-old man with a history of lung tuberculosis, which had been completely cured 4 years ago, presented to our emergency department with a productive cough and fever for 3 d. Tracing his history, he had undergone left lower lobe segmentectomy of the left lung due to lung abscess one year ago at another hospital. However, he developed refractory empyema postoperatively despite surgical intervention including decortication and flap reconstruction. After admission, we reviewed his previous medical images and noted a fistula tract between the left pleural cavity and splenic flexure. In addition, according to his medical records, bacterial culture of the thoracic drainage showed growth of Escherichia coli and Bacteroides fragilis. Our lower gastrointestinal series and colonoscopy confirmed the diagnosis of colopleural fistula. The patient underwent a left hemicolectomy, splenectomy, and distal pancreatectomy, and the diaphragm was repaired under our care. No further empyema recurrence was noted during follow-up.

CONCLUSION

Indicative signs of colopleural fistula include refractory empyema accompanied by the growth of colonic flora in the pleural fluid.

Keywords: Colopleural fistula; Lung abscess; Empyema; Colonic flora; Case report

Core Tip: Colopleural fistula is very rare and challenging in diagnosis. We reported a case of idiopathic colopleural fistula in an adult who presented with refractory empyema, and discussed several clinical findings which may help caregivers to diagnose.