Management of Postintubational Tracheal Injury by Endoscopic Stent Placement: Case Report and Review of the Literature

Abstract

Endobronchial stent placement is a novel therapy for treatment of iatrogenic tracheal tears. A review of the available literature shows surgery and long-term intubation being the established treatment strategy.

We describe the case of a 64-year-old woman with a tracheal rupture following endotracheal intubation for routine surgery. Pneumo-mediastinum and chest pain were the predominant symptoms. She was treated with a covered self-expandable metal stent that closed the tear and led to immediate symptom relief. After six weeks and complete healing of the trachea, the stent could be explanted. No stent complications occurred. A new algorithm for the treatment of these ruptures has been proposed.

Keywords

bronchial disease - tracheal injury - stent - anesthesia - benign lesion

• References

• 1 Berry M, Van Schil P, Van Meerbeeck J, Vanmaele R, Eyskens E. Surgical treatment of iatrogenic tracheal lacerations. Acta Chir Belg 1997; 97 (6) 308-310
• 2 Miñambres E, Burón J, Ballesteros MA, Llorca J, Muñoz P, González-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg 2009; 35 (6) 1056-1062
• 3 Evagelopoulos N, Tossios P, Wanke W, Krian A. Tracheobronchial rupture after emergency intubation. Thorac Cardiovasc Surg 1999; 47 (6) 395-397
• 4 Chen EH, Logman ZM, Glass PS, Bilfinger TV. A case of tracheal injury after emergent endotracheal intubation: a review of the literature and causalities. Anesth Analg 2001; 93 (5) 1270-1271
• 5 Wagner A, Roeggla M, Hirschl MM, Roeggla G, Schreiber W, Sterz F. Tracheal rupture after emergency intubation during cardiopulmonary resuscitation. Resuscitation 1995; 30 (3) 263-266
• 6 Marty-Ané CH, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg 1995; 60 (5) 1367-1371
• 7 Orta DA, Cousar III JE, Yergin BM, Olsen GN. Tracheal laceration with massive subcutaneous emphysema: a rare complication of endotracheal intubation. Thorax 1979; 34 (5) 665-669
• 8 Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg 1997; 12 (1) 98-100
• 9 Marquette CH, Bocquillon N, Roumilhac D, Nevière R, Mathieu D, Ramon P. Conservative treatment of tracheal rupture. J Thorac Cardiovasc Surg 1999; 117 (2) 399-401
• 10 Fan CM, Ko PC, Tsai KC , et al. Tracheal rupture complicating emergent endotracheal intubation. Am J Emerg Med 2004; 22 (4) 289-293
• 11 Jougon J, Ballester M, Choukroun E, Dubrez J, Reboul G, Velly JF. Conservative treatment for postintubation tracheobronchial rupture. Ann Thorac Surg 2000; 69 (1) 216-220
• 12 Harris R, Joseph A. Acute tracheal rupture related to endotracheal intubation: case report. J Emerg Med 2000; 18 (1) 35-39
• 13 Yopp AC, Eckstein JG, Savel RH, Abrol S. Tracheal stenting of iatrogenic tracheal injury: a novel management approach. Ann Thorac Surg 2007; 83 (5) 1897-1899
• 14 Madden BP, Loke TK, Sheth AC. Do expandable metallic airway stents have a role in the management of patients with benign tracheobronchial disease?. Ann Thorac Surg 2006; 82 (1) 274-278
• 15 Saad CP, Murthy S, Krizmanich G, Mehta AC. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest 2003; 124 (5) 1993-1999
• 16 Noppen M, Stratakos G, D'Haese J, Meysman M, Vinken W. Removal of covered self-expandable metallic airway stents in benign disorders: indications, technique, and outcomes. Chest 2005; 127 (2) 482-487
• 17 Gildea TR, Murthy SC, Sahoo D, Mason DP, Mehta AC. Performance of a self-expanding silicone stent in palliation of benign airway conditions. Chest 2006; 130 (5) 1419-1423
• 18 Conti M, Pougeoise M, Wurtz A , et al. Management of postintubation tracheobronchial ruptures. Chest 2006; 130 (2) 412-418
• 19 Beiderlinden M, Adamzik M, Peters J. Conservative treatment of tracheal injuries. Anesth Analg 2005; 100 (1) 210-214
• 20 Mussi A, Ambrogi MC, Menconi G, Ribechini A, Angeletti CA. Surgical approaches to membranous tracheal wall lacerations. J Thorac Cardiovasc Surg 2000; 120 (1) 115-118
• 21 Ambrogi MC, Mussi A, Ribechini A, Angeletti CA. Posterior wall laceration of the thoracic trachea: the transcervical-transtracheal approach. Eur J Cardiothorac Surg 2001; 19 (6) 932-934