Cardiothoracic Surgery: Fellow Case Report Slide: Cardiothoracic Surgery |

Endoluminal Repair of a Post-Intubation Tracheal Laceration FREE TO VIEW

Benoit Bibas, MD; Ricardo Terra, MPH; Paulo Pêgo-Fernandes, PhD
Author and Funding Information

University of São Paulo, Brazil, São Paulo, Brazil

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):43A. doi:10.1016/j.chest.2016.08.050
Text Size: A A A
Published online

SESSION TITLE: Fellow Case Report Slide: Cardiothoracic Surgery

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Wednesday, October 26, 2016 at 11:00 AM - 12:15 PM

INTRODUCTION: Iatrogenic laceration of the trachea is a direct complication of endotracheal intubation, percutaneous tracheostomy or rigid bronchoscopy, with an incidence of 0.05% to 0.5%. High-risk situations include emergency intubation, unskilled personnel, use of a stylet during intubation, manipulation of the tube with blocked cuff and the use of high-pressure cuffs.

CASE PRESENTATION: A 60-year-old patient presented to the emergency room with cough, fever and shortness of breath. Chest radiograph identified a left lower lobe pneumonia. Pulmonary sepsis ensued, with hypotension and progressive respiratory failure. She was transferred to the ICU. After several failed attempts, she was intubated with a guidewire. A chest radiograph showed that the tube was located at the right main stem bronchus. Soon after repositioning of the tube, massive subcutaneous emphysema occurred. The hypothesis of a tracheal laceration was made and the patient was taken to the OR. We perrformed a cervicotomy, with longitudinal opening of the trachea. A 5 mm/30o scope was introduced, and a 6 cm full laceration of the membranous wall that extended to the right main bronchus was identified. It was repaired through the tracheotomy, with a running suture of polyglactin 4-0. A tracheostomy cannula was placed. Post-operative CT scan showed minimal emphysema, and no signs of disruption of the suture. At the 10th post-operative day, new pulmonary infiltrate ensued. The patient died at the 14th post-operative day. Post-mortem examination showed that the tracheal laceration was fully healed.

DISCUSSION: Tracheal laceration is a rare but serious event. Conservative treatment can be accomplished in lesions of the upper trachea and with mild respiratory symptoms. A tracheostomy can also be performed. In larger and distal lesions lesions, surgical repair can be accomplished through a transtracheal repair or right thoracotomy. Endoluminal repair offers a safe and less invasive option to the classical operations, that have mortality rates of up to 70%. Even though this case had a bad outcome, ventilation was restored after the repair and the patient had no subcutaneous or mediastinal emphysema. Furthermore, necropsy examination showed that the suture was intact.

CONCLUSIONS: Tracheal lacerations are rare, but serious conditions. A minimally invasive approach with endoscopic suture of the laceration can be performed safely.

Reference #1: Welter S. Repair of tracheobronchial injuries. Thorac Surg Clin. 2014;24(1):41-50.

DISCLOSURE: The following authors have nothing to disclose: Benoit Bibas, Ricardo Terra, Paulo Pêgo-Fernandes

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Management of postintubation tracheal ruptures. J Thorac Cardiovasc Surg 2008;136(1):231-2; author reply 232.
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543