Staged multimodal endoscopic vacuum therapy for a complex gastro-pleuro-broncho-cutaneous fistula: A case report

Figure 1 Anterior pleural drain attached to a collection bag, and the posterior drain managed with a dressing in physical examination.

Figure 2 Fistulography. A: With the scope through the cutaneous orifice; B: Highlighting the broncho-pleural fistula.

Figure 3 Anatomical illustration of the gastro-pleuro-broncho-cutaneous fistula.

Figure 4 Endoscopic vacuum therapy and adjunctive therapies. A: Single endoscopic vacuum therapy tube with double drainage, inside the cavity and outside the cutaneous coverage with the two independent sponge suction tips; B: External sealed sterile occlusive dressing with external surgical thread; C: Endoscopic view of post bronchial fistula edge ablation using argon plasma coagulation; D: Custom-designed conical plug composed of collagen and cellulose.

Figure 5 Fistulography showing significant reduction in the cavity with total closure of the bronchial fistula.

Figure 6 Physical examination of the external cutaneous orifice.

Figure 7 Timeline of clinical management and key interventions. EVT: Endoscopic vacuum therapy; APC: Argon plasma coagulation; ICU: Intensive care unit.