The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Tracheal injuries cured without direct suturing: Report of two cases
Toshihiro IkedaTetsuhiko GoJun NakanoTomohito OkuboNaoya YokotaHiroyasu Yokomise
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2018 Volume 32 Issue 2 Pages 238-243

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Abstract

Airway injury is a rare complication of intubation and esophageal surgery. We report two cases of tracheal injuries managed without direct suturing. Case 1: A 75-year-old man underwent chemoradiotherapy after surgery for esophageal cancer, and developed a gastric tube bronchial fistula after the first surgery. The membranous wall of the trachea was injured during surgery to repair a reconstructed gastric tube bronchial fistula. Although direct suturing of the injured trachea was considered, there was a marked risk of suture failure owing to impaired blood flow secondary to radiation therapy. Therefore, we did not suture the tracheal injury and performed pectoral major muscular flap plombage for dead-space closure. The postoperative course was uneventful. Two weeks after the injury, bronchoscopic evaluation showed granulation at the site of the tracheal injury.

Case 2: A 74-year-old woman showed acute-onset respiratory distress. The patient was diagnosed with bronchial asthma attack, intubated, and placed on a respirator for observation. One day after intubation, marked subcutaneous emphysema was observed from the neck to anterior chest. Computed tomography (CT) and bronchoscopy showed injury of the membranous portion of the lower trachea. Two weeks after conservative medical management of the patient on a respirator, bronchoscopic evaluation showed granulation around the injured portion of the trachea.

In cases of membranous injury of the trachea, suturing the torn tissue is generally conducted for repair. However, if it is difficult to suture owing to the patient's condition, plombage for dead-space closure or conservative medical management is an option.

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© 2018 The Japanese Association for Chest Surgery
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