Conservative management of postoperative incomplete lung torsion without reoperation: first case report with 2-year favorable outcomes.

BACKGROUND

Lung torsion is a rare but serious postoperative complication in thoracic surgery, with traditional management requiring surgical intervention such as video-assisted thoracoscopic surgery or open thoracotomy. Reoperation carries significantly higher mortality rates and prolonged hospitalization compared to routine surgical outcomes. To date, no cases of successful conservative management of postoperative lung torsion have been reported in the literature. This case report presents the first successful conservative management of postoperative lung torsion, challenging the established surgical paradigm and offering new therapeutic possibilities.

CASE PRESENTATION: A 52-year-old male patient underwent dual-port video-assisted thoracoscopic surgery with right upper lobectomy and right lower lobe superior segmentectomy (RS6) for invasive pulmonary adenocarcinoma. Two hours after chest tube removal on postoperative day 2, the patient developed acute onset of profuse sweating, chest tightness, and dyspnea. Emergency chest radiography revealed complete lung atelectasis, and subsequent multidetector CT imaging combined with flexible bronchoscopy confirmed incomplete torsion of the right middle and lower lobes. A novel multimodal conservative approach was initiated, consisting of selective intrabronchial air insufflation every 48 h, noninvasive positive pressure ventilation (BiPAP), and maintained closed thoracic drainage. On postoperative day 7, three-dimensional imaging demonstrated significant resolution of atelectasis, and the chest tube was successfully removed. Three-month postoperative imaging revealed complete re-expansion of the residual right lung, with sustained expansion confirmed at 2-year follow-up without long-term sequelae.

CONCLUSIONS

This case represents the first successful conservative management of postoperative lung torsion using multimodal conservative therapy with excellent long-term outcomes. Conservative management may be considered for carefully selected patients with early-diagnosed incomplete lung torsion who remain hemodynamically stable without tissue infarction. This approach requires intensive monitoring and immediate surgical backup availability. While offering a potential alternative to high-risk reoperation, surgical intervention remains the standard of care, and larger studies are needed to validate this approach and establish treatment protocols.