Approach to Empyema Necessitatis

• Published in: World journal of surgery Vol. 35; no. 5; pp. 981 - 984
• Main Authors: Akgül, Asli Gül, Örki, Alpay, Örki, Tülay, Yüksel, Mustafa, Arman, Bülent
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.05.2011; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Cardiac Surgery; Chest Tube; Chest Tube Drainage; Empyema, Tuberculous - surgery; General aspects; General Surgery; Human bacterial diseases; Infectious diseases; Medical sciences; Medicine; Medicine & Public Health; Open Drainage; Pleural Space; Surgery; Thoracic Surgery; Tube Thoracostomy; Vascular Surgery; Open Drainage; Chest Tube Drainage; Pleural Space; Tube Thoracostomy; Chest Tube; Infection; Medicine; Empyema; Treatment; Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-011-1035-5

Background Thoracic empyema is a collection of pus in the pleural space. Empyema necessitatis is a rare complication of empyema, characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. We present nine cases of empyema necessitatis, including etiology, duration, and characteristics of clinical history, kind of surgery used, and treatment choices. Methods In a 4-year period nine patients were treated for empyema necessitatis. Six were male and 3 female with an age range of 13–89 years (median = 40 years). Results Empyema necessitatis was treated with drainage and antibiotherapy or antituberculosis therapy in three patients with the diagnosis of tuberculosis or nonspecific pleuritis. Decortication of the thoracic cavity was used in three patients successfully. Others were treated with open drainage. Final diagnoses were tuberculous empyema in five patients, chronic fibrinous pleuritis in three, and squamous cell carcinoma in one. Except for two patients, one with multisystem failure and one with squamous cell carcinoma, all were discharged with no complications. Conclusion Surgery plays a critical role in the management of empyema necessitatis in selected patients. Tube drainage, open drainage, and decortication are the choices in variable conditions for obliterating the cavity and regenerating pulmonary function.