{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:16:48Z","timestamp":1780917408928,"version":"3.54.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gen Thorac Cardiovasc Surg Cases"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary wedge resection is a lung-sparing procedure, with mechanical staplers enhancing surgical safety. Staple line reinforcement reduces air leakage; however, its effect on preventing mechanical vascular injury remains unclear. Staple-related vascular injuries rarely cause life-threatening complications. Here, we report a rare case of hemorrhagic shock caused by intercostal artery perforation from a protruding staple leg following thoracoscopic wedge resection with a reinforced stapler, which was likely triggered by lung collapse and re-expansion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 76-year-old man underwent thoracoscopic wedge resection of right segment 6 for suspected metachronous lung adenocarcinoma using a reinforced stapler with a gold cartridge. The surgery was uneventful. On postoperative day (POD) 1, accidental chest drain removal caused lung collapse. After drain reinsertion and lung re-expansion on POD 2, the patient developed hemorrhagic shock on POD 3. Emergency thoracotomy revealed massive intrathoracic hemorrhage from the eighth intercostal artery due to a staple leg protruding through the reinforcement and perforating the artery during lung inflation. Hemostasis was achieved using electrocautery and artery ligation, followed by removal of the protruding staple and additional staple line reinforcement. The postoperative course was uneventful, and the patient was discharged on POD 10.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mechanical vascular injury due to staple protrusion can occur despite reinforced staplers. Lung collapse and re-expansion may alter the spatial relationship between the staple line and adjacent chest wall vessels, thereby increasing arterial injury risk. Careful staple line inspection, appropriate cartridge selection based on tissue thickness, and chest drain management are essential for preventing this rare complication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s44215-026-00256-3","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:55:15Z","timestamp":1780916115000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Life-threatening hemorrhagic shock due to intercostal artery perforation from a protruding staple leg after pulmonary wedge resection with a reinforced stapler: a case report"],"prefix":"10.1186","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6694-725X","authenticated-orcid":false,"given":"Shin-nosuke","family":"Watanabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuta","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chisaki","family":"Ichinohe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsubasa","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiori","family":"Ono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirose","family":"Imai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahito","family":"Minakawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"issue":"3","key":"256_CR1","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/0003-4975(95)00537-u","volume":"60","author":"RJ Ginsberg","year":"1995","unstructured":"Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60(3):615\u201322. https:\/\/doi.org\/10.1016\/0003-4975(95)00537-u. discussion 622-3.","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"256_CR2","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.athoracsur.2005.07.078","volume":"81","author":"RJ McKenna Jr","year":"2006","unstructured":"McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81(2):421\u20135. https:\/\/doi.org\/10.1016\/j.athoracsur.2005.07.078. discussion 425-6.","journal-title":"Ann Thorac Surg"},{"issue":"7","key":"256_CR3","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1007\/s11748-018-01060-9","volume":"67","author":"M Yano","year":"2019","unstructured":"Yano M, Numanami H, Akiyama T, Taguchi R, Furuta C, Haniuda M. Reoperation for postoperative bleeding following pulmonary resection: a report of a single-center experience. Gen Thorac Cardiovasc Surg. 2019;67(7):608\u201314. https:\/\/doi.org\/10.1007\/s11748-018-01060-9.","journal-title":"Gen Thorac Cardiovasc Surg"},{"issue":"1","key":"256_CR4","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1510\/icvts.2009.203786","volume":"9","author":"H Motoyama","year":"2009","unstructured":"Motoyama H, Yamashina A, Chihara K. Sudden hemothorax following lobectomy caused by staple. Interact Cardiovasc Thorac Surg. 2009;9(1):117\u20138. https:\/\/doi.org\/10.1510\/icvts.2009.203786.","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"6","key":"256_CR5","doi-asserted-by":"publisher","first-page":"ivac275","DOI":"10.1093\/icvts\/ivac275","volume":"35","author":"M Yamaji","year":"2022","unstructured":"Yamaji M, Yano M, Okamoto S, Fukui T. Postoperative aortic injury caused by a staple line formed during wedge resection of the lung. Interact Cardiovasc Thorac Surg. 2022;35(6):ivac275. https:\/\/doi.org\/10.1093\/icvts\/ivac275.","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"12","key":"256_CR6","doi-asserted-by":"publisher","first-page":"rjz276","DOI":"10.1093\/jscr\/rjz276","volume":"2019","author":"H Negishi","year":"2019","unstructured":"Negishi H, Tsubochi H, Maki M, Endo S. Incidental haemothorax after sublobar resection: did staple line scratch chest wall? J Surg Case Rep. 2019;2019(12):rjz276. https:\/\/doi.org\/10.1093\/jscr\/rjz276.","journal-title":"J Surg Case Rep"},{"issue":"1","key":"256_CR7","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/s40792-023-01775-9","volume":"9","author":"T Yamashita","year":"2023","unstructured":"Yamashita T, Asai K. Delayed severe hemothorax caused by a staple line of a bullectomy performed 11 years earlier. Surg Case Rep. 2023;9(1):194. https:\/\/doi.org\/10.1186\/s40792-023-01775-9.","journal-title":"Surg Case Rep"},{"issue":"10","key":"256_CR8","doi-asserted-by":"publisher","first-page":"rjae620","DOI":"10.1093\/jscr\/rjae620","volume":"2024","author":"J Fang","year":"2024","unstructured":"Fang J, Liu Q, Wu C, Li J. Massive chest wall bleeding 3 days after lung wedge resection caused by a protruding staple. J Surg Case Rep. 2024;2024(10):rjae620. https:\/\/doi.org\/10.1093\/jscr\/rjae620.","journal-title":"J Surg Case Rep"},{"key":"256_CR9","doi-asserted-by":"publisher","unstructured":"Suyama Y, Nakada T, Watanabe Y, Nakashima M, Otani A, Tsukamoto Y, Shibazaki T, Kinoshita T, Ohtsuka T. A Case of Postoperative Pneumothorax due to a Dislodged Reinforced Staple Fragment After Thoracoscopic Segmentectomy: Recommendations for the Safe Use of Reinforced Staplers. Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70173. https:\/\/doi.org\/10.1111\/ases.70173.","DOI":"10.1111\/ases.70173"},{"key":"256_CR10","doi-asserted-by":"publisher","first-page":"305","DOI":"10.2147\/MDER.S67338","volume":"7","author":"E Chekan","year":"2014","unstructured":"Chekan E, Whelan RL. Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. Med Devices (Auckl). 2014;7:305\u201318. https:\/\/doi.org\/10.2147\/MDER.S67338.","journal-title":"Med Devices (Auckl)"}],"container-title":["General Thoracic and Cardiovascular Surgery Cases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-026-00256-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44215-026-00256-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-026-00256-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:55:16Z","timestamp":1780916116000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s44215-026-00256-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["256"],"URL":"https:\/\/doi.org\/10.1186\/s44215-026-00256-3","relation":{},"ISSN":["2731-6203"],"issn-type":[{"value":"2731-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"assertion":[{"value":"10 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was not required for this case report, in accordance with the institutional policy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for the publication of this case report and the accompanying images was obtained from the patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"24"}}