Tracheal Diverticulum Perforation with Mediastinal Emphysema During Lung Cancer Surgery Under General Anesthesia: a Case Study

Abstract

Background. Tracheal diverticulum is a rare disease with few reports on perforation. Case. We herein report the case of a woman with bronchial diverticulum who developed bronchial perforation during lung cancer surgery. The surgery was performed while the patient was in a left lateral position, and single-lung ventilation of the left lung was performed (35 Fr, double lumen). Intubation was conducted by the attending anesthesiologist with no adverse findings, and single-lung ventilation was initiated after 8 min. The surgery began 21 min after intubation, and marked mediastinal emphysema intrathoracically was observed via the first port. The patient was placed in a supine position, where an observation of the airway revealed a 3-mm diverticulum and air bubble adhering to the right side of the carina; it was determined that perforation of the tracheal diverticulum had occurred due to positive-pressure ventilation. Computed tomography findings confirmed the presence of a 3-mm tracheal diverticulum at the same site. It was confirmed that the surgery could be continued with single-lung ventilation without problems related to oxygenation. When the surgery resumed, the mediastinal pleura was opened up to the thoracic cavity to drain the mediastinal emphysema, and a 20-Fr trocar catheter was placed in the thoracic cavity at the end of the surgery. Conclusion. Despite the lack of reports on tracheal diverticulum perforation during anesthesia management, injury due to positive-pressure ventilation is a possible situation, and to prevent an abnormality, it is necessary to take measures while carefully considering the association of such a management approach with this condition.