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Case Reports
. 2021 Aug 30;21(1):208.
doi: 10.1186/s12871-021-01430-6.

Bronchial rupture following endobronchial blocker placement: a case report of a rare, unfortunate complication

Shuwen Oo  1 , Rachel Hui Xuan Chia  2 , Yue Li  3   4 , Hari Kumar Sampath  3   4 , Sophia Bee Leng Ang  2 , Suresh Paranjothy  2 , John Kit Chung Tam  3   4 , Chang Chuan Melvin Lee  2
Affiliations
Case Reports

Bronchial rupture following endobronchial blocker placement: a case report of a rare, unfortunate complication

Shuwen Oo et al. BMC Anesthesiol. .

Abstract

Background: Lung separation may be achieved through the use of double lumen tubes or endobronchial blockers. The use of lung separation techniques carries the risk of airway injuries which range from minor complications like postoperative hoarseness and sore throat to rare and potentially devastating tracheobronchial mucosal injuries like bronchus perforation or rupture. With few case reports to date, bronchial rupture with the use of endobronchial blockers is indeed an overlooked complication.

Case presentation: A 78-year-old male patient with a left upper lobe lung adenocarcinoma underwent a left upper lobectomy with a Fuji Uniblocker® as the lung separation device. Despite an atraumatic insertion and endobronchial blocker balloon volume within manufacturer specifications, an intraoperative air leak developed, and the patient was found to have sustained a left mainstem bronchus rupture which was successfully repaired and the patient extubated uneventfully. Unfortunately, the patient passed on in-hospital from sepsis and other complications.

Conclusion: Bronchial rupture is a serious complication of endobronchial blocker use that can carry significant morbidity, and due care should be exercised in its use and placement. Bronchoscopy should be used during insertion, and the volume and pressure of the balloon kept to the minimum required to prevent air leak. Bronchial injury should be considered as a differential in the presence of an unexplained air leak.

Keywords: Airway trauma; Bronchi; Bronchial blocker; Bronchial injury; Bronchial rupture; Intubation; Lung separation; Thoracic surgery.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A-C Preoperative (A, B) and postoperative (C) transverse CT images of the thorax
Fig. 2
Fig. 2
A-B Intraoperative photographs demonstrating the site of the perforation within the surgical field (A) and on bronchoscopy (B). Arrows delineate the location of the left mainstem bronchus rupture
See this image and copyright information in PMC

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