Metalloptysis and Bronchopulmonary Fistula after Sleeve Resection for Carcinoid. Rare or Not?

Bronchial neuroendocrine tumors (carcinoids) are a rare group of pulmonary neoplasms, and lung is the second most common site. Sleeve lobectomy is very useful to treat lesions involving main or lobar bronchi. We report the case of an unusual post-operative complication, involving the asymptomatic expectoration of surgical staplers over a 6-months period following a sleeve right upper lobectomy for a typical carcinoid. First episode was noted one month after the procedure. A rigid and flexible bronchoscopy was done. Airway was clear and the re-implanted lower lobe bronchus showed no dehiscence or obstruction. The patient returned as he has had at least six staples coughed up at unexpected episodes of severe coughing. He denied any haemoptysis, and his chest x-ray was satisfactory despite right-sided volume loss consistent with his surgery. Another rigid and flexible video assisted bronchoscopy performed and a stitch material from the apical lower lobe bronchus (at right side) was retrieved. There was no evidence of carcinoid recurrence.