2006 Volume 20 Issue 2 Pages 156-160
We report a difficult case who had repeated tracheal stenosis due to post-intubation tracheal stenosis. The patient was a 61-year-old woman with dyspnea due to severe heart failure. The patient was placed on artificial ventilation with tracheal intubation. A tracheal tube was removed 3 weeks later. Dyspnea occurred 3 weeks after tube retraction and the patient was again treated with endotracheal intubation, and referred to our hospital. The trachea was obliterated and torn 3 cm from 2 cm below the tracheostomied region. Additionally, there was subglottic stenosis. Following induction of a T-tube, a 3 cm sleeve resection of the trachea (4 tracheal cartilage rings) was performed with end-to-end suture using 17 stitches with a 2-0 absorbable monofilament. Pathological findings of the surgical specimen showed degeneration and necrosis of the tracheal cartilage with excessive growth of granulation tissues. A tracheostomy tube was intubated from the tracheostomied region postoperatively and removed on the 75th postoperative day. However, the patient complained of wheezing and dyspnea 3 months later. An emergent tracheostomy was necessary and regrowth of granulation tissues was found at the previously tracheostomied region. A self-expanding metallic stent was placed in the trachea, and a silicon tube was placed in the tracheostomied region. Although subglottic stenosis and mild stenosis of the tracheostomied region were observed postoperatively, stenosis was alleviated with various treatments. Currently, there has been no adverse effect on daily life.
