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Shah SB, Pant D, Koul A. A glimmer of hope in delayed presenting complete bronchial transections? Lung India 2023; 40:366-367. [PMID: 37417094 PMCID: PMC10401974 DOI: 10.4103/lungindia.lungindia_106_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/12/2023] [Accepted: 03/12/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Shreya B. Shah
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Deepanjali Pant
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India E-mail:
| | - Archna Koul
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India E-mail:
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2
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Aljehani Y, Aldossary I, AlQatari AA, Alreshaid F, Alsadery HA. Blunt Traumatic Tracheobronchial Injury: a Clinical Pathway. Med Arch 2022; 76:430-437. [PMID: 36937611 PMCID: PMC10019869 DOI: 10.5455/medarh.2022.76.430-437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Motor vehicle collisions (MVC) are a major burden on healthcare systems. Saudi Arabia is one of the countries with a high mortality rate of MVC. Blunt tracheobronchial injuries are rare; however, it is a catastrophic event that requires a high center of care. Lack of experience and advanced faculty prompt early stabilization and transfer of the victim for advanced care. Due to the uncertainty of management of these injuries, we would like to share our experience in dealing with such injuries. Objective To address the difficulties in initial management and transfer of patient with blunt traumatic tracheobronchial injuries. Methods This is a single-center retrospective case-series study including patients admitted as cases of trauma including all age groups with blunt acute tracheobronchial injuries confirmed by imaging or bronchoscope. Results In our study, four patients with tracheobronchial injuries were identified, and a retrospective analysis was performed. Two of the males and one of the females are adults, while the other two are pediatrics. Two of them have a right main bronchial injury and the other two have a left main bronchial injury. Posterolateral thoracotomy and bronchial anastomosis were performed on all four patients and were followed up. Conclusion In Saudi Arabia, blunt trauma is a prevalent type of injury, although tracheobronchial injuries are uncommon. In the event of trauma, a high index of suspicion of tracheobronchial injuries in a high mechanism injury warrants prompt treatment. Due to a lack of experienced and specialized hands in this field, management may be delayed, and eventually lead to unfavorable outcomes, hence we thought of a guide to facilitate the decision-making.
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Affiliation(s)
- Yasser Aljehani
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibrahim Aldossary
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Abdulaziz AlQatari
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Farouk Alreshaid
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Humood Ahmed Alsadery
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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3
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Aljehani Y, Aldossary I, AlQatari AA, Alreshaid F. WITHDRAWN: Blunt traumatic tracheobronchial injury: A case series and a clinical pathway. Ann Med Surg (Lond) 2022. [DOI: 10.1016/j.amsu.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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4
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Fan QM, Yang WG. Use of a modified tracheal tube in a child with traumatic bronchial rupture: A case report and review of literature. World J Clin Cases 2021; 9:8915-8922. [PMID: 34734075 PMCID: PMC8546802 DOI: 10.12998/wjcc.v9.i29.8915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Trauma is one of the leading causes of death in the pediatric population. Bronchial rupture is rare, but there are potentially severe complications. Establishing and maintaining a patent airway is the key issue in patients with bronchial rupture. Here we describe an innovative method for maintaining a patent airway.
CASE SUMMARY A 3-year-old boy fell from the seventh floor. Oxygenation worsened rapidly with pulse oxygen saturation decreasing below 60%, as his heart rate dropped. Persistent pneumothorax was observed with insertion of the chest tube. Fiberoptic bronchoscopy was performed, which confirmed the diagnosis of bronchial rupture. A modified tracheal tube was inserted under the guidance of a fiberoptic bronchoscope. Pulse oxygen saturation improved from 60% to 90%. Twelve days after admission, right upper lobectomy was performed using bronchial stump suture by video-assisted thoracic surgery without complications. A follow-up chest radiograph showed good recovery. The child was discharged from hospital three months after admission.
CONCLUSION A modified tracheal tube could be selected to ensure a patent airway and adequate ventilation in patients with bronchial rupture.
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Affiliation(s)
- Qi-Meng Fan
- Pediatric Intensive Care Unit, Shenzhen Children's Hospital, Shenzhen 518000, Guangdong Province, China
- Medical College, Shantou University, Shantou 515063, Guangdong Province, China
| | - Wei-Guo Yang
- Pediatric Intensive Care Unit, Shenzhen Children's Hospital, Shenzhen 518000, Guangdong Province, China
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5
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Maddali MM, Zacharias S, Kandachar PS, Annamalai A, Abolwafa A, Ananthasubramanian R, Nguyen K, Diaz-Castrillon CE, Viegas M. Bronchial Disruption Repair in a Child: Suggestions for Opting for One-Lung Ventilation or Extracorporeal Circulatory Support. J Cardiothorac Vasc Anesth 2020; 34:3146-3153. [PMID: 32684429 DOI: 10.1053/j.jvca.2020.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
| | - Sunny Zacharias
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | | | - Anbarasu Annamalai
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | - Amr Abolwafa
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | | | - Khoa Nguyen
- Department of Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Melita Viegas
- Department of Pediatric Cardiac Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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6
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Abstract
INTRODUCTION Given the concern for radiation-induced malignancy in children and the fact that risk of severe chest injury in children is low, the risk/benefit ratio must be considered in each child when ordering a computed tomography (CT) scan after blunt chest trauma. METHODS The study included pediatric blunt trauma patients (age, <15 years) with chest radiograph (CR) before chest CT on admission to our adult and pediatric level I trauma center. Surgeons were asked to view the blinded images and reads and indicate if they felt CT was warranted based on CR findings, if their clinical management change based on additional findings on chest CT, and how they might change management. RESULTS Of the 127 patients identified, 64.6% had no discrepancy between their initial CR and chest CT and 35.4% of the children's imaging contained a discrepancy. The majority of the pediatric and general trauma surgeons felt CT was indicated in 6 of 45 patients based on CR. In 87% of patients with a discrepancy in findings on CR and CT, the majority of surgeons agreed that their management would not change based on the additional information. In the 6 patients in which the CT was considered indicated, 4 of the 6 would have triggered a management change. CONCLUSIONS Our study suggests that chest CT scans frequently serve as confirmatory diagnostic tools and in the pediatric blunt chest trauma patient and can be withheld in many cases without hindering the management of an injured child.
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7
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Abstract
Damage control is a surgical strategy that has evolved and expanded considerably over the past 25 years. The approach was initially developed as a "bail out" procedure to control bleeding with severe abdominal injuries in the setting of unmitigated hemorrhagic shock. Damage control is now more broadly applied as a comprehensive management plan for the resuscitation and surgical treatment of injured patients with exhausted physiologic and metabolic reserve. This article reviews the most current concepts in damage control that are important and relevant to the practicing pediatric surgeon. It also provides evidence-based recommendations about how damage control principles can be pragmatically applied to severely injured children. This review focuses specifically on the fundamentals of damage control with respect to resuscitation and the operative treatment of children with severe abdominal, thoracic, and extremity injuries.
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Affiliation(s)
- Anthony Tran
- Pediatric Surgery and Injury Prevention Center, Connecticut Children's Medical Center, Hartford, Connecticut 06106
| | - Brendan T Campbell
- Pediatric Surgery and Injury Prevention Center, Connecticut Children's Medical Center, Hartford, Connecticut 06106.
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8
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Vane DW, Keller MS, Sartorelli KH, Miceli AP. Pediatric Trauma: Current Concepts and Treatments. J Intensive Care Med 2016. [DOI: 10.1177/088506602237107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Injured children represent a complex management problem for the trauma surgeon. Physiologic and psychological factors have been shown to influence outcome; however, more importantly, injury patterns and treatment algorithms differ from those recommended for adults. Children often do well after major injuries, but surgeons must use appropriate treatment to maximize the physiologic responses and the innate healing abilities of the growing child. Historically, surgeons have defined childhood as prepubertal, but a child's physiologic response to injury extends well into the third decade of life, making treatment of a 20-year-old similar to that of a 10-year-old, rather than that of a 40-year-old. The distribution of pediatric trauma facilities across the country has limited the access of the injured child to these centers. Adult centers more often serve as the first and definitive treatment provider for children. This article reviews the current concepts of trauma treatments for children. It is hoped that the adult trauma surgeons caring for injured children might gain information that will be of assistance in their daily practice.
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Affiliation(s)
- Dennis W. Vane
- Division of Pediatric Surgery, University of Vermont College of Medicine, Burlington, VT,
| | | | - Kennith H. Sartorelli
- Division of Pediatric Surgery, University of Vermont College of Medicine, Burlington, VT
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9
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Abstract
Thoracic injury in children deserves special attention because, although it accounts for less than 10% of traumatic injuries in children, there is a significant associated morbidity and mortality. This review discusses the anatomic and physiologic factors resulting in such injury severity with blunt thoracic trauma in children. Specific organ injuries, including most common chest wall injuries, hemo- and pneumothoraces, and pulmonary parenchymal injuries, are discussed, encompassing epidemiology, presentation, diagnosis, and management. Rare injuries including tracheobronchial tree injuries, cardiovascular injuries, esophageal injuries, and diaphragmatic injuries are also briefly discussed.
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Affiliation(s)
- Hanna Alemayehu
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
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10
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Hosalli V, Ambi US, Ganeshnavar A, Hulakund S, Prakashappa D. Anaesthetic considerations in primary repair of tracheobronchial injury following blunt chest trauma in paediatric age group: Experience of two cases. Indian J Anaesth 2013; 57:410-2. [PMID: 24163462 PMCID: PMC3800340 DOI: 10.4103/0019-5049.118541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Vinod Hosalli
- Department of Anaesthesiology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
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11
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Abstract
Chest trauma in children is caused by high-energy blows, due in general to traffic accidents, that involve several other body regions. They occur mainly in the first decade of life and can be penetrating but are more often non-penetrating. Rib fractures and lung contusions, sometimes associated with pneumothorax or haemothorax, are the more usual injuries, but tracheobronchial rupture, cardiac, oesophageal or diaphragmatic injuries may also occur. These injuries are treated with supportive respiratory and haemodynamic measures, drainage of air or blood from the pleural space and, at times, surgical repair of the injured organ(s). Ruptures of the airway may be difficult to treat and occasionally require suture, anastomosis or resection. Oesophageal injuries can be treated conservatively with antibiotics, drainage and parenteral nutrition. Diaphragmatic tears should be repaired operatively. Overall mortality ranges from 6 to 20%. Mortality is high but this is mainly due to the associated presence of extra-thoracic trauma, and particularly to head injuries.
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Affiliation(s)
- Juan A Tovar
- Department of Paediatric Surgery, Hospital Universitario La Paz and Department of Paediatrics, Universidad Autonoma de Madrid, Madrid, Spain.
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12
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Hashimoto K, Ohtsuka T, Goto T, Anraku M, Kohno M, Izumi Y, Nomori H. Complete laceration of the middle lobe bronchus caused by blunt trauma. Ann Thorac Cardiovasc Surg 2012; 19:148-50. [PMID: 22971710 DOI: 10.5761/atcs.cr.12.01936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bronchial ruptures due to blunt trauma are rarely encountered injuries. A previously healthy 42-year-old man fell from heights of 8 meters. A prompt chest tube-drainage for suspected right sided tension pneumothorax and a tracheal intubation were performed. Massive air leak and pneumothorax of the right lung continued. Laceration of the tracheobronchial tree was suspected. Operation was performed 20 hours after patient's arrival. The complete avulsion of the middle lobe bronchus was identified during operation, and a middle lobectomy was performed. The patient was transferred to a rehabilitation hospital on 20th post-operative day without complication. Early decision making for surgery resulted in a good outcome. When a complete atelectasis of the whole right lung and a massive air leakage continues despite appropriate chest-tube drainage in a blunt trauma patient, laceration of the tracheobronchial tree should be suspected.
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Affiliation(s)
- Kohei Hashimoto
- Division of General Thoracic Surgery, Department of Surgery School of Medicine, Keio University, Tokyo, Japan
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13
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Dhua AK, Ratan SK, Aggarwal SK. Use of pre and intra-operative bronchoscopy in management of bronchial injury following blunt chest trauma. J Indian Assoc Pediatr Surg 2011; 16:113-4. [PMID: 21897575 PMCID: PMC3160053 DOI: 10.4103/0971-9261.83498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Blunt chest trauma resulting in right bronchial tear in an 8-year-old girl is reported. Use of bronchoscopy in the management of such an injury is highlighted.
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Affiliation(s)
- Anjan Kumar Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
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14
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15
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Chang W. Emergency Bilobectomy under the Extracorporeal Membrane Oxygenation Support for Pediatric Patient with Blunt Traumatic Bronchial Transection -A case report-. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wonho Chang
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital
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16
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Boubia S, Fouraiji K, Elkari A, Sibai H, Chlilek M, Ridai M. [Tracheobronchial rupture in childhood]. Arch Pediatr 2010; 17:1059-61. [PMID: 20456931 DOI: 10.1016/j.arcped.2010.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 10/29/2009] [Accepted: 03/18/2010] [Indexed: 01/06/2023]
Abstract
Tracheobronchial rupture after blunt trauma is rare, especially in a pediatric population. In this paper, we report the case of a 3-year-old child who presented with a rupture of the tracheobronchial tree as a result of multiple injuries (thoracic and cerebral) sustained from a traffic accident. The surgical repair consisted of a sleeve resection (right upper lobectomy with reanastomosis of the bronchus intermedius to the right stem bronchus). As tracheobronchial rupture is a rare condition, particularly in children, physicians must have a high index of suspicion. The diagnosis and treatment of this condition are discussed.
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Affiliation(s)
- S Boubia
- Service de chirurgie thoracique, aile II, CHU Ibn Rochd, Casablanca, Morocco.
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17
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Sanli M, Isik AF, Tuncozgur B, Elbeyli L. Successful repair in a child with traumatic complex bronchial rupture. Pediatr Int 2010; 52:e26-8. [PMID: 20158641 DOI: 10.1111/j.1442-200x.2009.03000.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Maruf Sanli
- Gaziantep University, Medical School, Thoracic Surgery Department, Gaziantep, Turkey.
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18
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Liu YH, Liu HP, Wu YC, Ko PJ. Feasibility of transtracheal thoracoscopy (natural orifice transluminal endoscopic surgery). J Thorac Cardiovasc Surg 2009; 139:1349-50. [PMID: 19945122 DOI: 10.1016/j.jtcvs.2009.09.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 09/22/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Yun-Hen Liu
- Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, and the School of Medicine Chang Gung University, Taiwan, China
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19
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Propst EJ, Lin EP, Istaphanous GK, Boesch RP, Ryckman FC, Cotton RT, Rutter MJ. Management of traumatic tracheobronchial separation in a teenager using a fabricated extra-long endotracheal tube. Int J Pediatr Otorhinolaryngol 2009; 73:1163-7. [PMID: 19450887 DOI: 10.1016/j.ijporl.2009.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 04/09/2009] [Accepted: 04/09/2009] [Indexed: 11/17/2022]
Abstract
Tracheobronchial separation (TBS) due to blunt chest trauma in children is extremely rare. We report the case of a 14-year-old boy who fell 20 feet and developed respiratory distress, bilateral pneumothoraces, pneumomediastinum, and subcutaneous emphysema. Computed tomography imaging at the initial institution failed to detect tracheobronchial disruption, and the patient was managed conservatively. The patient's worsening condition prompted bronchoscopic examination which revealed complete separation of the right main bronchus from the trachea. Single-lung ventilation was instituted using a fabricated extra-long nasotracheal tube due to the patient's large size and mandibular fracture, and the airway was primarily anastamosed with an open thoracotomy approach. The clinical features of tracheobronchial separation as well as anesthetic, clinical and surgical management of this rare but life-threatening injury are described.
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Affiliation(s)
- Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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20
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Van Hoorebeke E, Jorens PG, Wojciechowski M, Salgado R, Desager K, Van Schil P, Ramet J. An unusual case of traumatic pneumatocele in a nine-year-old girl: a bronchial tear with clear bronchial laceration. Pediatr Pulmonol 2009; 44:826-8. [PMID: 19598274 DOI: 10.1002/ppul.20806] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-traumatic pneumatoceles (traumatic pulmonary pseudocysts) after blunt thoracic trauma are not frequently observed. It is widely accepted that pneumatoceles are caused by compression of the lung resulting in bursting parenchyma, followed by decompression of the chest with negative intrathoracic pressure. We present a case of post-traumatic pneumatocele in a nine-year-old girl who was crushed under the tailboard of a horse hamper. A multislice CT of the thorax clearly demonstrated a bronchial laceration pointing to bronchial disruption as an additional causative mechanism.
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Affiliation(s)
- Evelyn Van Hoorebeke
- Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
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21
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Dudda M, Frangen TM, Muhr G, Schinkel C. [Posttraumatic tracheal stenosis after complex fracture of the upper cervical spine: a rare complication]. Unfallchirurg 2009; 112:734-7. [PMID: 19440677 DOI: 10.1007/s00113-009-1625-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Combined injuries of the upper cervical spine are rare and can lead to life-threatening positional changes of the respiratory tract. Hence, it is very important to recognize tracheal and soft tissue injuries and to treat these adequately. We report on the clinical course and outcome of a case with a delayed high-grade tracheal stenosis after cervical spine injury, which could only be treated by emergency tracheotomy and partial transverse trachea resection.The 25-year-old female suffered a complex dislocated upper cervical spine fracture with a Jefferson fracture, an odontoid fracture and a dislocated C6/7 luxation fracture after a motor vehicle accident. Immediately after trauma inspiratory stridor was reported. Postoperatively, the tracheal stenosis increased and the histological examination of tissue collected during emergency bronchoscopy showed granulation tissue.Even if fractures of cervical spine injuries are treated successfully, soft tissue and tracheal injuries cannot be precluded. Therefore, it is most important that such patients are followed-up closely to classify the problem and to determine the ideal time for surgical treatment of tracheal injuries and stenoses.
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Affiliation(s)
- M Dudda
- Chirurgische Klinik und Poliklinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
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22
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Schedlbauer EM, Todt I, Ernst A, Seidl RO. Iatrogenic tracheal rupture in children: A retrospective study. Laryngoscope 2009; 119:571-5. [DOI: 10.1002/lary.20107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Dango S, Sienel W, Kopp KH, Passlick B. Successful Repair of a Subtotal Rupture of Distal Tracheobronchial Tree With Complete Abridgment of the Right Bronchus in a 4-Year-Old Child. Ann Thorac Surg 2008; 86:1020-2. [DOI: 10.1016/j.athoracsur.2008.02.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 02/10/2008] [Accepted: 02/18/2008] [Indexed: 01/12/2023]
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Abstract
Chest trauma is the second greatest cause of mortality from trauma, a leading cause of death in children over the age of one. Prompt diagnosis can be difficult as the underlying thoracic injuries are often disproportionately severe compared to the visible surface injury and symptoms may not appear for several hours. Diagnosis are easily underestimated, delayed or missed. This is the second of a 2 part article reviewing Paediatric chest trauma and its current management. The injuries are usefully classified into 6 lethal injuries that need excluding in the primary survey and 6 hidden injuries that must be considered in the secondary survey. The 6 lethal injuries are covered in the first part of this article along with biomechanics and mechanisms of injury. This article looks in depth at the 6 hidden injuries, along with a review of chest trauma in non-accidental injury.
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Affiliation(s)
- Maya Kerr
- Paediatric A&E SpR, St Mary's Hospital,
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25
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Fette A, Aufdenblatten C, Lang F, Schwöbel M. Emergency call: Trachea rupture in a child. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.pedex.2007.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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26
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Abstract
Thoracic trauma is relatively frequent in children and causes considerable mortality. This is mainly due to the multiorganic nature of the trauma. The lung is more often affected even in the absence of rib fractures because of the considerable pliability of the chest wall that allows direct transfer of energy to this organ. Injuries to the heart, the aorta, the esophagus, and the diaphragm are rare. Lung contusion and laceration cause parenchymal hemorrhage and consolidation sometimes accompanied by pneumothorax and/or hemothorax. Tracheobronchial disruption is rare but life-threatening. Most traumatic lung injuries may be treated with rest, respiratory support, and eventually intercostal drainage. Large hemorrhage may require thoracotomy, and persistent pneumothorax (indicative of tracheobronchial disruption) may require intubation with fiberoptic bronchoscopic assistance and eventually reparative or ablative surgery. Adult respiratory distress syndrome is very rarely seen in children with thoracic trauma, but it remains highly lethal.
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27
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Affiliation(s)
- Lindsey A Nelson
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0764, USA.
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28
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Clay J, Gates RL. Nonoperative management of bronchial injury in a 21-month-old child. JOURNAL OF SURGICAL EDUCATION 2007; 64:224-7. [PMID: 17706576 DOI: 10.1016/j.jsurg.2007.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 01/25/2007] [Accepted: 01/28/2007] [Indexed: 05/16/2023]
Abstract
Bronchial laceration is an uncommon complication of blunt trauma in children. Treatment of bronchial laceration has involved thoracotomy with primary repair of the bronchial injury or nonoperative management with tube thoracostomy. We report a 21-month-old boy who sustained a large tear of the right upper lobe bronchus after an automobile/pedestrian accident in whom nonoperative management resulted in a favorable outcome. The relevant literature is reviewed, and an algorithm for management is proposed.
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Affiliation(s)
- Jared Clay
- Department of Surgery, University of California - Davis Health System, Sacramento, California, USA
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29
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Duval EL, Geraerts SD, Brackel HJ. Management of blunt tracheal trauma in children: a case series and review of the literature. Eur J Pediatr 2007; 166:559-63. [PMID: 17028881 DOI: 10.1007/s00431-006-0279-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 07/27/2006] [Indexed: 02/06/2023]
Abstract
Blunt tracheal trauma seldom develops in children because of their anatomy and the mobility of the cartilage. It has the potential to be overlooked, either because of the severity of concomitant injuries or because of the unfamiliarity of paediatricians with this type of injury. However, tracheal injury might be lethal due to airway compromise. Early bronchoscopy may be necessary to anticipate complications and prevent permanent dysfunction. We present a retrospective, double-institution case series over a 5-year period, describing five children, aged 3 to 14 years, with tracheal injury after blunt cervical trauma. All patients showed emphysema with pneumomediastinum. After explorative bronchoscopy, all patients were successfully treated with antibiotics and/or supportive ventilation. In summary, minimal lesions due to blunt tracheal trauma could be treated conservatively in children. Since the external signs of tracheal injury are not indicative of the extent of the trauma, a high index of suspicion is warranted in these patients.
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Affiliation(s)
- Elisabeth L Duval
- Pediatric Intensive Care, Queen Paola Children's Hospital, Lindendreef 11, Antwerp, Belgium.
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30
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Jamal-Eddine H, Ayed AK, Perić M, Ben-Nakih ME. Injuries to the major airway after blunt thoracic trauma in children: review of 2 cases. J Pediatr Surg 2007; 42:719-21. [PMID: 17448774 DOI: 10.1016/j.jpedsurg.2006.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tracheobronchial injuries in children occur rarely. Their diagnosis is often very difficult and needs a high degree of suspicion, with in-depth knowledge of the anatomy of and radiological findings for the chest. With proper surgical management, even a delayed diagnosis can result in normal lung function. We discuss 2 cases of major airway injuries with successful outcomes and present some interesting surgical maneuvers.
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Affiliation(s)
- Hassan Jamal-Eddine
- Thoracic Surgical Department, Chest Diseases Hospital, Kuwait City, Safat 13041, Kuwait
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31
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Abstract
Tracheobronchial rupture after a blunt chest trauma is rare, especially in children. If the diagnosis is overlooked, severe ventilatory complications or mediastinitis may occur. We describe a case of a 4-year-old girl with a rupture of the right main bronchus after she was hit by a frame of steel (like a mini goal) that fell down while she was playing. The diagnosis was initially missed owing to a variety of symptoms. Difficulty with ventilation and persistent air leak after insertion of a chest tube in the case of a pneumothorax is suspect for a tracheobronchial rupture. This emphasizes once again the importance of the concept of rechecking and searching for the underlying cause when a pneumothorax persists. Bronchoscopy is the gold standard in establishing the diagnosis. Surgical treatment is in most cases the best option, especially in a ventilated patient. Without treatment mortality rates are up to 30%. In conclusion, tracheobronchial rupture should be excluded if mediastinal emphysema or a persistent air leak is present after a blunt thoracic trauma.
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Affiliation(s)
- Petra Nugteren
- Department of Anaesthesiology, VU University Medical Centre, 1007 MB Amsterdam, The Netherlands
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32
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Abstract
A 10-year-old boy fell from a tree and sustained blunt injury to his chest. He was brought to the hospital (6 h later) with difficulty in breathing and inability to speak. There was a bruise on the neck and extensive subcutaneous emphysema over the neck and chest and decreased air entry over the right hemithorax. Radiographs revealed a right-sided pneumothorax, pneumomediastinum and tracheal deviation. An intercostal drain (with underwater seal) was inserted and he was transferred to the operating room for bronchoscopy. Anesthesia was induced with IV midazolam and ketamine. The trachea was intubated orally and anesthesia maintained with spontaneous breathing of halothane in oxygen. Flexible fiberoptic bronchoscopy performed via the tracheal tube revealed no injury to bronchi or carina. Bronchoscopy through the tracheal tube withdrawn to the level of the vocal cords revealed a 1-cm long posterior longitudinal tear approximately 2-3 cm below the cords. The surgeons planned a definitive tracheostomy distal to the traumatic tracheal opening. This was difficult and initially unsuccessful because of subcutaneous emphysema. A ureteric catheter was introduced through the tracheal tube and a tracheostomy tube mounted on the fiberoptic bronchoscope, which was then inserted through the surgical tracheostome. This followed the ureteric catheter into the distal trachea and the trachea was successfully cannulated. We review the mechanism of tracheal injuries with special reference to its occurrence in children with blunt injury. We discuss the airway management in these potentially life-threatening injuries.
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Affiliation(s)
- Naveen Eipe
- Anaesthesia, Padhar Hospital, Padhar, Madhya Pradesh, India.
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33
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Bingol-Kologlu M, Fedakar M, Yagmurlu A, Fitoz S, Dindar H, Gokcora IH. Tracheobronchial rupture due to blunt chest trauma: report of a case. Surg Today 2006; 36:823-6. [PMID: 16937288 DOI: 10.1007/s00595-005-3240-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
Abstract
Tracheobronchial injuries following blunt chest trauma are uncommon in children. The involvement of both the trachea and right main bronchus separately is highly unusual. We herein report the case of a 13-year-old boy who presented with both a tracheal and right main bronchial rupture following blunt chest trauma. While the tracheal laceration required a tracheotomy, a delayed repair of right main bronchial disruption was performed with a complete preservation of the right lung. The features of this uncommon entity are discussed, with special emphasis on early diagnosis and surgical management.
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Affiliation(s)
- Meltem Bingol-Kologlu
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, 06100 Dikimevi, Ankara, Turkey
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34
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Abstract
Spontaneous tracheobronchial ruptures are uncommon injuries, especially in the pediatric age group. Tracheal injuries, independent of their origin, may be life-threatening. Here we present the first report of a 14-year-old boy who presented with subcutaneous emphysema, pneumomediastinum, and pneumothorax on day 3, due to spontaneous posterior tracheal-wall rupture following paroxysmal productive coughing. The diagnosis was established using a computed tomography scan of the chest, and tracheobronchoscopy and esophagoscopy under general anesthesia. He was endotracheally intubated and ventilated in the intensive care unit. Such tracheal defects, bridgeable by an endotracheal tube, may permit conservative treatment. The patient was discharged on day 10, and follow-up revealed no late complications.
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Affiliation(s)
- Ahmet Akyol
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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35
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Graham J, Davidson AJ. Anaesthesia for major orthopaedic surgery in a child with an acute tracheobronchial injury. Anaesth Intensive Care 2006; 34:88-92. [PMID: 16494157 DOI: 10.1177/0310057x0603400103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 12-year-old boy presented after a motorbike accident with mediastinal and cervical emphysema but no pneumothorax, minor head injury and several fractures including a comminuted open leg fracture. The child had no signs of respiratory compromise and was stable. The presumed tracheobronchial injury was managed conservatively. To avoid general anaesthesia and the risks associated with intubation and ventilation, urgent surgery for correction of his orthopaedic injuries was successfully conducted under spinal, epidural and intravenous regional anaesthesia. The surgical and anaesthetic management of tracheobronchial injury is complex and controversial.
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Affiliation(s)
- J Graham
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria
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36
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Abstract
Respiratory obstruction resulting from a discrete haematoma within the dorsal tracheal membrane was seen in an 11-year-old neutered female greyhound that had been involved in a fight two days earlier. There was no history or evidence of rodenticide toxicity or other coagulopathy, and it is suggested that the tracheal haematoma resulted from trauma. A right third intercostal thoracotomy was performed and this allowed resection of the haematoma from within the dorsal membrane of the cranial thoracic trachea, relieving the obstruction with no subsequent signs of dyspnoea. Intramural haematoma should be considered as a rare differential diagnosis for dogs presenting with acute respiratory obstruction.
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Affiliation(s)
- J J Pink
- University Veterinary Hospital, School of Agriculture, Food Science and Veterinary Medicine, College of Life Sciences, University College Dublin, Belfield, Dublin 4, Ireland
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37
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Self ML, Mangram A, Berne JD, Villarreal D, Norwood S. Nonoperative Management of Severe Tracheobronchial Injuries with Positive End-Expiratory Pressure and Low Tidal Volume Ventilation. ACTA ACUST UNITED AC 2005; 59:1072-5. [PMID: 16385281 DOI: 10.1097/01.ta.0000188643.67949.82] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael L Self
- Department of Surgery, Methodist Health System, Dallas Medical Center, Dallas, Texas, USA
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38
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Okumuş M, Celik A, Gün F, Yekeler E. Complete bronchial rupture in a child: report of a case. Pediatr Surg Int 2005; 21:665-8. [PMID: 15912366 DOI: 10.1007/s00383-005-1434-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2005] [Indexed: 12/30/2022]
Abstract
Tracheobronchial rupture due to blunt chest trauma is a rare and serious injury in children. The diagnosis is usually difficult and may be overlooked because of the variability of symptoms and findings. Fiberendoscopy is useful in children with stable tracheal or bronchial ruptures. However, in the emergency situation, fiberendoscopy may not be appropriate, and thoracotomy and primary anastomosis may be the best option.
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Affiliation(s)
- Mustafa Okumuş
- Department of Pediatric Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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39
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Weber P, Vastmans J, Gärtner C, van Boemmel T, Hofmann GO. [Bronchial rupture combined with luxation fracture of the thoracic spine following direct trauma]. Unfallchirurg 2005; 107:1093-8. [PMID: 15292957 DOI: 10.1007/s00113-004-0792-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tracheobronchial injuries in blunt thoracic trauma are very rare (incidence: under 1%), with potentially devastating consequences. Appropriate pre-, intra-, and postoperative management is mandatory to ensure the patient's survival and maintain lung function. We report the case of a 62-year-old male patient hit by a tree over the chest while cutting down trees, suffering a rupture of the right bronchus and a tear of the trachea combined with a luxation fracture of the thoracic spine between Th2 and Th3 (without neurological deficit). With immediate suture of the torn bronchus and trachea and stabilization of the spine fracture on the following day, we achieved a successful outcome in this patient. To our knowledge, this is the first description in the literature of the combination of both injuries.
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Affiliation(s)
- P Weber
- Berufsgenossenschaftliche Unfallklinik Murnau
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40
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Beale P, Bowley DM, Loveland J, Pitcher GJ. Delayed repair of bronchial avulsion in a child through median sternotomy. ACTA ACUST UNITED AC 2005; 58:617-9. [PMID: 15761360 DOI: 10.1097/01.ta.0000071845.16204.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Peter Beale
- Division of Paediatric Surgery, Johannesburg Hospital, Johannesburg, South Africa
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41
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Abstract
Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.
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Affiliation(s)
- Kennith H Sartorelli
- From the Department of Surgery, Division of Pediatric Surgery, University of Vermont, Burlington, VT 05401, USA
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42
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Naghibi K, Hashemi SL, Sajedi P. Anaesthetic management of tracheobronchial rupture following blunt chest trauma. Acta Anaesthesiol Scand 2003; 47:901-3. [PMID: 12859314 DOI: 10.1034/j.1399-6576.2003.00179.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Injuries to the tracheobronchial tree are a well-recognized sequel of massive blunt trauma to the chest, and although unusual, are life threatening. We report a 16-year-old-boy who developed complete disruption of both bronchi after a motor vehicle accident. After induction of general anaesthesia and oral intubation, ventilation could not be maintained, and oxygenation worsened abruptly with peripheral oxygen saturation values less than 60%. Jet ventilation through two intrabronchial catheters, inserted via emergency thoracotomy, raised the saturation from 60% to 100%, and surgery thereafter was straightforward. The anaesthetic management of tracheobronchial repair is discussed.
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Affiliation(s)
- K Naghibi
- Isfahan University of Medical Sciences, Isfahan, Iran
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43
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Abstract
The authors report the case of a 5-year-old boy who received a blow from a heavy metallic bar on the front of the neck and presented with a complete rupture of the cervical trachea. Such a rupture is exceptional in children because of the consistency of the cartilage but can occur when the neck is in extension and the glottis is closed. A rigid endoscopy allowed the rupture to be diagnosed, to restore the airway, to prepare the cervicotomy, and the suturing of the trachea. He presented with a stenosis 50 days after the suturing which was treated by dilatation.
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Affiliation(s)
- Stephane Feat
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Rennes University Hospital, Cedex, France
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44
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Nakamori Y, Hayakata T, Fujimi S, Satou K, Tanaka C, Ogura H, Nishino M, Tanaka H, Shimazu T, Sugimoto H. Tracheal rupture diagnosed with virtual bronchoscopy and managed nonoperatively: a case report. THE JOURNAL OF TRAUMA 2002; 53:369-71. [PMID: 12169950 DOI: 10.1097/00005373-200208000-00031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yasushi Nakamori
- Department of Traumatology, Osaka University Medical School, Osaka, Japan.
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45
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Kacmarynski DSF, Sidman JD, Rimell FL, Hustead VA. Spontaneous tracheal and subglottic tears in neonates. Laryngoscope 2002; 112:1387-93. [PMID: 12172250 DOI: 10.1097/00005537-200208000-00012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Spontaneous rupture of the trachea or subglottis as a complication of difficult delivery has not been reported in the United States literature. There have been a few cases reported in the European literature. The present report describes a series of newborns with this complication and discusses the signs and treatment options of this difficult, life-threatening problem. STUDY DESIGN Retrospective review. METHODS Newborns born between 1996 and 2001 who were treated for spontaneous subglottic or tracheal rupture at a tertiary care children's hospital neonatal intensive care unit were reviewed. RESULTS Four cases of spontaneous subglottic rupture were seen at the hospital. In three of the four cases the tracheas were intubated on an emergency basis after subcutaneous air was noted in the anterior aspect of the neck. In the fourth patient the trachea was not intubated until the subglottic tear was visualized intraoperatively. Two of the four patients died. One died without securing of an airway; the other died of complications of prolonged hypoxia. Eight cases from European literature of spontaneous neonatal subglottic and tracheal tears are reviewed and are compared with the cases presented in the current report. CONCLUSIONS Early detection of airway rupture by flexible endoscopy is essential for timely diagnosis and appropriate treatment. Standard endotracheal intubation can exacerbate the problem and should be deferred if possible until direct airway visualization can be accomplished. Signs associated with tracheal tears include subcutaneous emphysema, respiratory distress, pneumothorax, and pneumomediastinum. These should lead to emergent consultation with otolaryngologists for examination and securing of the airway.
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Affiliation(s)
- Deborah S F Kacmarynski
- Children's Hospital-Minneapolis and the Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
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46
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Chu CPW, Chen PP. Tracheobronchial injury secondary to blunt chest trauma: diagnosis and management. Anaesth Intensive Care 2002; 30:145-52. [PMID: 12002920 DOI: 10.1177/0310057x0203000204] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tracheobronchial injury is an uncommon complication in blunt chest trauma. The typical clinical features include haemoptysis, dyspneoa, and air leak. Tracheobronchial injury occurs after high energy impact and is commonly associated with injuries of other vital organs. If tracheobronchial injury is undetected and left untreated, it may cause persistent air leak which can render ventilation difficult and inefficient. Diagnosis of tracheobronchial injury should be made and confirmed by flexible bronchoscopy. The essence of airway management is to bypass the lesion by means of endobronchial intubation to the healthy bronchus with a single-lumen or double-lumen endotracheal tube. Such manoeuvres can also facilitate surgical access if thoracotomy is indicated. Taking into account the size of the lesion and the resulting respiratory status, surgical reconstruction of the injured airway is often necessary. More severe injury may even require lobectomy or pneumonectomy. Late complications of untreated tracheobronchial injury include bronchial stenosis, recurrent pneumonia and bronchiectasis. Prompt diagnosis and treatment generally lead to good functional recovery.
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Affiliation(s)
- C P W Chu
- Department of Anaesthesiology, Intensive Care and Operating Services, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
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47
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Corsten G, Berkowitz RG. Membranous tracheal rupture in children following minor blunt cervical trauma. Ann Otol Rhinol Laryngol 2002; 111:197-9. [PMID: 11913678 DOI: 10.1177/000348940211100301] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Injuries to the tracheobronchial tree are well-recognized sequelae of massive blunt or penetrating injuries of the neck or chest. They may also occur as a rare complication of endotracheal intubation. We present 2 cases of a less well-recognized clinical entity, rupture of the membranous trachea following minimal blunt trauma to the neck in children. The case histories and management of this disorder are discussed. Recognition and treatment of this problem requires a high index of suspicion for the lesion and timely investigations. Open repair of the trachea to secure a stable airway is recommended for this injury, unless the wound is small and the wound edges are well approximated.
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Affiliation(s)
- Gerard Corsten
- Department of Otolaryngology, Royal Children's Hospital, Melbourne, Australia
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48
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Kaptanoglu M, Dogan K, Nadir A, Gonlugur U, Akkurt I, Seyfikli Z, Gunay I. Tracheobronchial rupture: a considerable risk for young teenagers. Int J Pediatr Otorhinolaryngol 2002; 62:123-8. [PMID: 11788144 DOI: 10.1016/s0165-5876(01)00600-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Tracheobronchial (TB) ruptures are ten times lower in children than in adults. Despite its rarity in the literature, we found that it is as common as in adults in our series. We investigated TB ruptures in childhood regarding age, trauma presentation, injury localization and treatment options. From 1994 through 2001, eight children (six male, two female) were admitted to our department with TB injury. All patients were healthy prior to trauma. The average and median ages were 9.8 and 11, respectively. All patients except one (iatrogenic) were suffering from blunt thoracic trauma. There were seven main bronchial (five right, two left) and one tracheal wounds. Six of the ruptures were circumferential. Urgent (n=6) and delayed (n=2) thoracotomies were performed; 'end-to-end' anastomosis (n=4), pneumonectomy (n=2) and 'primary suturing' (n=2) were applied. We had no mortality. Main bronchus rupture was overlooked in two patients as one of them had almost totally normal clinical appearance, and the other one had negative endoscopic findings. Both of these patients were successfully operated within 3 months. Our limited experience showed us that these kinds of injuries threaten school age population as well. False negative bronchoscopic results increase when additional injuries accompany. TB ruptures should be always taken into consideration after blunt chest trauma. Early or late repair of the lesion should be decided depending on the patient's clinical course.
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Affiliation(s)
- Melih Kaptanoglu
- Faculty of Medicine, Department of Thoracic Surgery, Cumhuriyet University, Sivas, Turkey.
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49
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Long J, Reynolds E, Wong J, LaSpada J. Traumatic airway disruption in children. THE JOURNAL OF TRAUMA 2001; 51:1200-3. [PMID: 11740279 DOI: 10.1097/00005373-200112000-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Long
- Department of Surgery, Broward General Medical Center, Fort Lauderdale, Florida, USA
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