When Decortication Is A Breath Of Fresh Air

 Dr. Snankhydip Pramanik (Sr. Consultant CTVS - Ruby General Hospital) 

A 30 year old young man had been presented with sudden onset of shortness of breath and recurrent fever for one month along with a history of Type II Diabetes mellitus. He had been admitted under the expert care of Dr. Sankhadip Pramanik (Cardiothoracic and Vascular Surgeon) who clinically assessed him and relevant investigations were sent for. Due to the pandemic scenario investigation for COVID – 19 (RT –PCR) had also been advised which resulted negative. In addition two units of Packed Red Blood Cells (PRBC) had also been transfused. CT scan of chest had been done followed by Bronchoscopy. After discussion with the family members and with informed consent the gentleman had been posted for surgery. Decortication of left lung had been done with the help of double lumen tube (Endotracheal tube designed to isolate the lungs anatomically and physiologically). Around 1.5 litres of pus had been evacuated from the chest, the lung was completely collapsed.

Decortication is a surgical procedure involving the removal of the surface layer, membrane, or fibrous cover overlying the lung, chest wall and diaphram. The procedure is usually performed when the lung is covered by a thick, inelastic pleural peel restricting lung expansion. Decortication is performed to remove all the fibrinous peel and necrotic tissue, to help the lung reexpand, and, equally important, not to leave any residual air spaces. The two most common problems encountered in performing decortication are pleural-cavity infection and fibrosis. The postoperative period was uneventful and the gentleman had been discharged on the fourth postoperative day.

Location: Kolkata, West Bengal, India

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