Six weeks intercostal drainage for recurrent tuberculous hydropneumothorax - port sudan teaching hospital

Background: Tuberculosis is a major health problem in Sudan; the annual rate is 77/100.000, and it is the commonest endemic disease in Port Sudan. Hydropneumothorax which is a rare complication that may recurrent after first intercostal drainage which is usually not respond to intercostal drainage up to seven days after which it needs thoracic surgery intervention either video assisted thoracoscope or even open thoracic surgery and there is no facilities for both in Port Sudan - Red sea state – Sudan, so a trail of six weeks intercostal drainage and antituberculous therapy under direct observed therapy strategy ( DOTS) was done in order to overcome this problem and it showed a reasonable respond with minimal complications.
Method: This is a prospective interventional hospital based study which was done in Port Sudan teaching hospital from July 2010 to June 2018.
10356 tuberculous patients were seen, (0.002%) of them developed recurrent hydropneumothorax, those were hospitalized , history was taken , physical examination and CXR were done and pleural fluid was examined for protein, cells and gene X pert. 28 F chest tube introduced and those patients were followed clinically and radiologically while they continue on antituberculous therapy
Results: From 10356 tuberculous patients 24 patients (0.002%) developed recurrent hydropneumothorax, 20 (83%) male, 4 (17%) female. Recurrence occurs between two to twelve days after first intercostal drainage. 16 patients (67%) were cases of hydropnemothorax, 4 patients pyopneumothorax and 2 patients (8.3%) were haemopneumothorax.
18 patients (75%) presented with cough, 18 patients (75%) SOB, 22 patients (91.7%) presented with chest pain and 5 patients (20.8%) presented with haemoptysis.
Pleural fluid was exudative in all patients and in all samples mycobacterium tuberculosis was not detected with gene Xpert. Radiological findings beside hydropnemothorax showed cystic changes in 16 patients (66.7%), fibrotic changes in 16 patients (66.7%), and cavity formation in 6 patients (25%).
Reexpansion occur in 22 patients (91.7%) and in 2 (8.3%) patients intercostal drainage didn't success and they died, 10 patients (41.7%) developed surgical emphysema, 4 (16.7%) patients developed bronchopleural fistula and 2 (8.3 %) patients developed empyema necessitatis.
Success rate for management of hydropneumothorax in Port Sudan teaching hospital with six weeks intercostal drainage was 91.7% with 100% success in those with hydropneumothorax and haemopneumothorax and 50% in those with pyopneumothorax.
Conclusion: Recurrent tuberculous hydropneumothorax although it is very rare, but it has serious morbidity. Risk factors for recurrent hydropneumothorax in those tuberculous patients are bronchiectasis and patients with fibrotic and / or cavitatory radiological changes.
6 weeks intercostal drainage can replace thoracic surgery in managing recurrent hydropneumothorax and it showed good outcome with minimal complications that in majority resolved during course of management and rarely need further intervention.