Treatment of Bronchopleural Fistula with Watanabe Spigots

Bronchopleural fistula (BPF) is a known complication of necrotizing pneumonia that is treated primarily with pleural drainage and antimicrobial therapy, while surgical treatments are generally reserved for those who do not respond to conservative management.Endobronchial spigots -a potentially less invasive approach to the treatment of bronchial occlusioncan be utilized when the culprit bronchi can be isolated and successfully blocked.We describe here the case of a 44-year-old female with a persistent right lower lobe bronchopleural fistula complicating necrotizing MRSa pneumonia, despite pleural drainage and directed antimicrobial therapy.The use of an endobronchial spigot for the bronchial occlusion of two bronchopulmonary segments led to an immediate reduction in the size of a large pleural cavity, contributing to significant symptomatic and biochemical improvement.The treatment can thus be considered an alternate cost-effective minimally invasive approach to the management of non-resolving bronchopleural fistula.