Tracheal rupture after endotracheal intubation - A report of three cases -

Abstract

Tracheal rupture is a rare but serious complication that occurs after endotracheal intubation. It usually presents as a linear lesion in the membranous wall of the trachea, and is more prevalent in women and patients older than 50 years. The clinical manifestations of tracheal injury include subcutaneous emphysema and respiratory distress. We report the cases of three female patients of old age presenting tracheal rupture after endotracheal intubation. Two cases received surgical repair without complication and one recovered uneventfully after conservative management. We presume that the tracheal injuries were caused by over-inflation of cuff and sudden movement of the tube by positional change. Therefore, we recommend cuff pressure monitoring during general anesthesia and minimized movement of the head and neck at positional change.

Keywords: Airway; Intubation; Rupture; Subcutaneous emphysema; Trachea.

Fig. 1

Chest CT showing the injury of the posterior tracheal wall and pneumomediastinum due to the rupture of the pars membranosa (arrow).

Fig. 2

A chest X-ray in the posteroanterior view showing pneumomediastinum, subcutaneous emphysema and pneumothorax.

Fig. 3

Diagnostic bronchoscopy revealing a linear laceration of 3-4 cm in length on posterior membranous wall of mid-trachea.

Fig. 4

Chest CT showing a laceration on the posterior membranous wall of mid-trachea (arrow).