To present an unusual case of severe tracheal stenosis treated with a silicon stent, left in place during 12 years.
Review of patient records.
A 29-year-old female schisophrenic patient presented with a catatonic state when she was 17 years old, requiring long term mechanical ventilation. She needed a tracheotomy to wean from the ventilator. One year later she was hospitalized again with respiratory insufficiency requiring a second tracheotomy. She developed a tracheo-esophagic fistula in the mid trachea, and underwent corrective surgery (resection and anastomosis). A Montgomery T tube was left in the trachea during 5 months, and then discontinued after and endoscopic examination showed satisfactory tracheal diameter.Three months later she presented to the emergency room complaining of progressive shortness of breath and stridor. A new bronchoscopy revealed a severe reduction in the tracheal lumen, with an 80% stenosis of approximately 2 cm in length. Significant retraction of both the lateral and posterior tracheal walls was observed; the soft tissue around had a great tendency to collapse (malacia). Since she was not considered a good candidate for a new surgery, a silicon stent (Dumon 13x50mm) was placed, with significant symptomatic improvement. The patient underwent periodical follow-up bronchoscopies, to assess both the status of the tracheal wall and the stent. The silicon prosthesis was changed approximately every two years. A progressive improvement in the malatic trachea was observed over time. Recently, it was decided to discontinue the prosthesis since the compromised tracheal segment was no longer stenotic and did not present wall collapse. After six months, patient is stable and asymptomatic. Neither stenosis nor malacia have relapsed to present.
To our knowledge, this is the first case a prosthesis has been left in place during a 12 year period.
It is possible to keep a silicon prosthesis during prolonged periods of time to treat complex tracheal stenosis in selected patients. In such cases, periodical follow up bronchoscopies are mandatory, and regular prosthesis changes may be necessary.
S. Padrones Sanchez, None.