European Respiratory Society


E. M. Hadley, P. J. Rees

To the Editors:

Here, we report the case of an interesting and unusual post-operative complication, involving the asymptomatic expectoration of 17 surgical staples over a 2-yr period following thoracic surgery for a pulmonary aspergilloma.

A 55-yr-old female had a resection of her left upper lobe and part of the apical segment of the left lower lobe to treat massive haemorrhage from a pulmonary aspergilloma. Eleven months later, she coughed up an open surgical staple. Over the next 3.5 yrs, she coughed up a further 12 single staples at regular intervals (fig. 1a). Recently, she expelled four linked, closed staples (fig. 1b).

Fig. 1—

Photographs displaying some of the staples the patient expelled. a) The third staple expelled. b) The expelled four linked, closed staples. Scale bars = 0.2 mm (a) and 500 µm (b).

Throughout this time, she has remained clinically well and there has been no change in her chest radiographs other than a reduction in the number of staples. In previous cases, this problem has been associated with buttressing of the staples with bovine pericardium 1. This case shows that metalloptysis of staples can occur alone over a prolonged period with no serious consequences.