2021 Volume 43 Issue 3 Pages 231-236
Background. Previous studies have shown that the combination of surgical resection and reconstruction of the trachea is the preferred treatment for post-intubation tracheal stenosis. In recent years, endoscopic dilatation has proven successful in several cases for treating tracheal stenosis thanks to advances in endoscopic equipment and technology. However, the indications and long-term outcomes remain unclear. Case. A 23-year-old woman presented to an outside emergency department following a motor vehicle collision (MVC), where she was found to be minimally responsive. She underwent endotracheal intubation in the emergency department and shortly after admission with mechanical ventilation and remained intubated for 5 days following the MVC. She presented to the outside hospital on day 40 after extubation with a persistent cough and dyspnea that was initially diagnosed as bronchial asthma. Her symptoms continued despite 1 year of inhaled corticosteroid use, and the patient was referred to our hospital. Chest computed tomography (CT) revealed severe tracheal stenosis with scarring and a 2.1-cm contraction. At this time, the diagnosis of post-intubation tracheal stenosis was made. We performed emergent tracheal dilatation using a rigid bronchoscope. However, re-stenosis occurred after a few weeks. Bronchoscopic dilatation was performed 2 additional times. After the third episode of stenosis following dilatation, we performed tracheal resection and reconstruction with end-to-end anastomosis. The patient has shown no signs of re-stenosis in 30 months since surgery. Conclusion. Endoscopic dilatation can be attempted following post-intubation tracheal stenosis. However, given the risk of re-stenosis following the procedure, tracheal resection and reconstruction remain the surgical treatment of choice, especially for cases with scarring contraction.
