Management of tracheobronchial injuries

Abstract

Tracheobronchial injury is one of cases which are relatively uncommon, but must be suspected to make the diagnosis and managed immediately. In such a case, primary initial goals are to stabilize the airway and localize the injury and then determine its extend. These can be possible mostly with flexible bronchoscopy conducted by a surgeon who can repair the injury. Most of the penetrating injuries occur in the cervical region. On the other hand, most of the blunt injuries occur in the distal trachea and right main bronchus and they can be best approached by right posterolateral thoracotomy. The selection of the manner and time of approaching depends on the existence and severity of additional injuries. Most of the injuries can be restored by deploying simple techniques such as individual sutures, while some of them requires complex reconstruction techniques. Apart from paying attention to the pulmonary toilet, follow-up is crucial for determination of anastomotic technique or stenosis. Conservative treatment may be considered an option with a high probability of success in patients meeting the criteria, especially in patients with iatrogenic tracheobronchial injury.

Keywords: Trachea; bronchus; injury.

Figure 1. a–d.

Six-month-old boy. Organic foreign body aspiration. Hyperinflation in the left lung (a). Organic foreign body was extracted by rigid bronchoscopy from the left bronchial system. Post-bronchoscopy X-ray revealed pneumothorax on the left side (b). Bronchial perforation (15 mm) was seen by re-bronchoscopy (c). Perforated part of left main bronchus was repaired by interrupted 4/0 monofilament absorbable sutures through a right mini thoracotomy (d).

Figure 2. a–c.

Twenty-two y/m. Air leakage from the penetrating wound was seen in the left side of the neck. 4 cm long laceration of the cervical trachea on the left side was repaired by monofilament absorbable sutures.

Figure 3. a–d.

15 y/m. He had a history of traffic accident. Rigid bronchoscopy was performed due to left atelectasis (a, b). Total obstruction of the left main bronchus was seen via rigid bronchoscopy (c). The distal stenotic segment of the left main bronchus was resected and end-to-end anastomosis was performed by left thoracotomy. Postoperatively X-ray (d).