RT Journal Article
SR Electronic
T1 Combined intrapleural alteplase and DNase therapy in complicated pleural infection arising from postsurgery oesophageal leak
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e249927
DO 10.1136/bcr-2022-249927
VO 16
IS 8
A1 Ng, Boon Hau
A1 Nik Abeed, Nik Nuratiqah
A1 Ban, Andrea Yu-Lin
A1 Abdul Hamid, Mohamed Faisal
YR 2023
UL http://casereports.bmj.com/content/16/8/e249927.abstract
AB Managing a complicated pleural infection related to postsurgery can pose a clinical challenge, especially when initial interventions such as intercostal chest drain and antibiotics prove ineffective. We describe a man in his mid-60s who developed a recurrence of exudative pleural effusion caused by an oesophageal leak following laparoscopic total gastrectomy with Roux-y oesophagojejunostomy for gastric adenocarcinoma. Surgical repairs and oesophageal stenting were performed to address the oesophageal leak. Despite attempts at intercostal chest tube drainage, ultrasonography-guided targeted drainage of the locule and antibiotics, he did not show any improvement. He was unfit for surgical decortication. Due to the risk of bleeding, we chose a modified dose of intrapleural alteplase 5 mg and DNase 5 mg at 12-hour intervals for a total of three doses. This led to the complete resolution of the effusion. This case highlights that intrapleural tPA/DNase can be an adjunctive therapy in postsurgery-related complicated pleural effusion.