Inadverted Perforation of Trachea: An Enigma or A Challenge
DOI:
https://doi.org/10.14738/bjhmr.104.15113Keywords:
Trauma, Respiratory tract, Tracheal perforation, subcutaneous emphysema, PneumothoraxAbstract
Introduction: traumatic injuries to the respiratory tract are rare, only a small portion of the trachea is unprotected above the manubrium sternalis, exposing the neck. The incidence is low and mortality is very high, higher than 82%. Objective: report of a case and analysis of the literature. Case reports: 46-year-old male who was admitted to the emergency room with four gunshot wounds to the thorax and extremities, vital signs: T/A: 139/36 mm Hg. HR: 107 bpm. RF: 20rpm. Temp 36.9°C. Sat 97%. Glasgow 6 points, neck with increased volume at the expense of subcutaneous emphysema, predominantly on the right, which extends to both hemithorax. Discussion: the clinical presentation of this pathology is non-specific. They present with generalized subcutaneous soft tissue emphysema, explosive and overwhelming, pneumomediastinum and/or pneumothorax. Other added signs may be respiratory failure, hemoptysis, or shock. The specific diagnosis is bronchoscopic but the most sensitive study is computed tomography, it is necessary to have the adequate inputs or resources, as well as the expertise of multidisciplinary personnel. Endoscopic treatment is the primary approach with a success rate of 50%; however, if it fails or is not feasible, early surgical treatment is mandatory. Conclusions: tracheal perforations are so complex that they require multidisciplinary management, with a third level medical care infrastructure. Surgery is the mainstay in resolving treatment in emergency or elective cases, its delay is a catastrophic outcome for the patient.
References
Vilar-Puig P., Cortés-Cisneros A., Chavolla-Magaña R., y Molina-Ramírez L. Historia de la traqueostomía. Anales de Otorrinolaringología Mexicana. 2016; 61(2):163-168.
Granholm T., and Farmer D.L. The surgical airway. Respir Care Clin N Am. 2001; 7(1):13-23.
Abdul-Hadi M.S., Ruiz-Mojica C.A., Rivera-Rivera G., et al. Incidental Tracheocele as an Unusual Presentation of Pneumomediastinum in the Trauma Setting. Am J Case Rep. 2023; 24:e937916.
Herrera M.A., Tintinago L.F., Victoria-Morales W., et al. Damage control of laryngotracheal trauma: the golden day. Colomb Med. 2020; 51(4):1-9.
Guo X., and Ji H. Management of Tracheal Perforation following Anterior Cervical Spine Surgery: Report of Two Cases and Review of the Literature. Case Rep Orthop. 2022; 2022:1914642.
Calva-Maldonado M., Lozano Camacho S. M., y García Contreras N.J. Lesión traqueal como hallazgo radiológico. A propósito de un caso. Revista Chilena de Anestesia. 2021; 50 (3):506-510.
McCollough C.H., Rajendran K., and Leng S. Standardization and Quantitative Imaging With Photon-Counting Detector CT. Invest Radiol. 2023; 58(7):451-458.
Armas-Zárate F.J., Morales-Gómez J., Vázquez-Minero, J.C., y Barrientos-Morales E.G. Perforación del tercio distal de la tráquea. A propósito de un caso. Neumología y Cirugía de Tórax. 2022; 81: 192-196.
López-Morales P., Candel-Arenas M.F, Martínez-Sanz N., et al. Perforación traqueal diferida tras cirugía tiroidea en un paciente con radioterapia cervical. Cir. Cir. 2023; 91(1): 113-116.
Wang B.B., Wang J.X., Chen H.G., and Yang RJ. [A case of corrosive digestive tract and lung injury caused by ingestion of pipeline dredging agent]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2023; 41(5):375-378.
Danielian S.N., Tarabrin E.A., Rabadanov K.M., et al. Postintubatsionnyi razryv grudnogo otdela trakhei u bol'noi s perforatsiei pishchevoda pri fibroendoskopii i mediastinitom [Post-intubation rupture of thoracic trachea in a patient with iatrogenic esophageal perforation and mediastinitis]. Khirurgiia (Mosk). 2023;(1):89-93.
Seenarain V., Trivedi A., Flukes S., and Tjhin WE. Diagnosis and surgical repair of delayed tracheal perforation post thyroidectomy in context of previous cranio-spinal radiotherapy - A case report. Int J Surg Case Rep. 2022; 91:106761.
Wen S., Unuma K., Watanabe R., and Uemura K. Diagnosis by forensic autopsy of cannula malposition resulting in fatal tension pneumothorax after attempted percutaneous tracheostomy: A short communication. J Forensic Leg Med. 2021; 81:102177.
Lucas-Benítez L. N., et al. Complicaciones asociadas a la colocación de dispositivos frecuentes en el paciente crítico. Evaluación radiológica: lo esencial. Acta Med GA. 2022; 20 (4): 329-337.
Grewal H.S., Dangayach N.S., Ahmad U., et al. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest. 2019; 155(3):595-604.
Passera E., Orlandi R., Calderoni M., et al. post-intubation iatrogenic tracheobronchial injuries: The state of art. Front Surg. 2023; 10:1125997.
Basanta-Bergolla D., Torres-Cuevas B-L., y Astudillo Reyes L.A. Síndrome de Mounier-Kuhn. Rev cubana. 2021; 60(Suppl 1): e1367. URL: http://dx.doi.org/10.14738/bjhmr.104.15113 109
Kalverkamp S., Störmann P., Graeff P., and Raab S. Traumatische tracheobronchiale Verletzungen –Empfehlung der interdisziplinären Arbeitsgruppe der DGT und DGU zur Etablierung einer einheitlichen Klassifikation für Diagnostik und Therapie [Traumatic Tracheobronchial Injuries - Recommendation of the Interdisciplinary Working Group of the DGT and DGU to Establish a Uniform Classification for Diagnostics and Therapy]. Zentralbl Chir. 2023; 148(1):85-92.
Bagga B., Kumar A., Chahal A., et al. Traumatic Airway Injuries: Role of Imaging. Curr Probl Diagn Radiol. 2020; 49(1):48-53.
Moser J.B., Stefanidis K., and Vlahos I. Imaging Evaluation of Tracheobronchial Injuries. Radiographics. 2020; 40(2):515-528.
Harpreet S.G., Neha S.D., Usman A., et al, Treatment of tracheobronchial injuries: A contemporary review, Chest Journal. 2019; 155(3):595-604.
Vázquez-Minero J.C., Morales-Gómez J., Guzmán de Alba E., y cols. Trauma traqueal penetrante. Recomendaciones para su manejo. A propósito de un caso. Neumol Cir Torax. 2018; 77(4): 286-292.
Zapata R., Naranjo C., Méndez M., et al. Reconstrucción traqueal bajo oxigenación con membrana para circulación extracorpórea para el manejo de una lesión traumática: reporte de caso y revisión bibliográfica. Rev Colomb Cir. 2018; 33:211-9.
Grant A.A., Lineen E.B., Villamizar N.R., et al. Traumatic Tracheal Injury and Pulmonary Contusions: Buying Time With ECMO. Am Surg. 2021; 87(12):2006-2008.
Sakai W., Nawa Y., Junichi O. Obstructive shock due to tracheal perforation following long-term placement of a tracheostomy tube in a pediatric patient: a case report. JA Clin Rep. 2022; 8(1):31. doi: 10.1186/s40981-022-00522-7.
Brunner S.., Bruns CJ., Schröder W. Ösophagotracheobronchiale Fisteln [Esophagotracheal and esophagobronchial fistulas]. Chirurg. 2022; 92(6):577-588.
Mann C., Musholt T.J., Babic B., et al. Chirurgische Versorgung ösophagotrachealer und -bronchialer Fisteln [Surgical treatment of esophagotracheal and esophagobronchial fistulas]. Chirurg. 2019; 90(9):722-730.
Rammos C.K., Anderson R.C., Taege S.M., et al. Treatment of Synchronous Traumatic Perforations of the Trachea and the Esophagus with Two Inferiorly Based Strap Muscle Interposition Flaps: An Innovative Approach. J Craniofac Surg. 2019; 30(4): e330-e332.
Flores-Salazar L.O., González-Tovar J., Hernández-Guedea M.A., et al. Lesión traqueal con reparación de colgajo muscular. Rev Cubana Cir [Internet]. 2019; 58(1): 121-127.
Rodríguez-Zapater S., López-Mínguez S., Bonastre C., et al. Implantación de stents biodegradables traqueales en animal de experimentación. Descripción de la técnica. Intervencionismo. 2019; 19(2):83-88.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Giselle Castillo García, Morelos Adolfo García Sánchez, Mireya De La Fuente González, Alejandro Altamirano Jiménez, Judá Raquel Hernández Salvador, Juan Carlos Hernández Ordónez, Omar Cáceres Von Roehrich, Juan Rubén Trejo Rosas, Julio César Barajas Moreno, Nancy Adelina Velasco Viloria
This work is licensed under a Creative Commons Attribution 4.0 International License.
