Management of tracheobrochial injuries: a 10-year experience at Ratchaburi hospital

Tracheobronchial injuries are rare but life threatening. Their successful diagnosis and treatment require a high level of suspicion and early surgical repair The authors review their experience in managing these injuries over the past 10 years.

Patients who were admitted to the Thoracic Surgical Unit, Ratchaburi Hospital and treated for tracheobronchial injuries from 1993 to 2004 were included in the present study. Hospital records were reviewed on mechanism of injury, clinical presentation, diagnosis, management and outcome.

The present series comprised of 11 tracheobronchial injury patients. Causal mechanism of injury was 4 blunt and 7 penetrating injuries. 4 of them with blunt injury, there were 3 right main bronchial disruptions, 1 minor cervical laceration. Presenting signs included dyspnea in 4 and subcutaneous emphysema in 3. 1 of them had massive air leak. Radiographic finding were pneumomediastinum in 3. Pneumothorax in 2, Atelectasis of right lung in 1. All of the right bronchial disruptions had primary repair with reanastomosis in 2 and resection of stenotic bronchus with reanastomosis in 1; this patient developed empyema thoracis with Acinetobacter iwoffii as a result of delayed diagnosis (40 day). One patient with minor cervical laceration underwent conservative treatment. All patients with blunt injuries were discharged with a normal patency of airway. 7 patients with penerating injuries, there were 4 cervical, 1 cervical associated with esophageal injury, 1 combined cervical-thoracic type of injuries and 1 Thoracic injury. Presenting signs included dyspnea in 7 and subcutaneous emphysema in 6. The radiographic finding were pneumomediastinum in 5 pneumothorax in 4, one patient underwent tracheal reanastomosis. The rest of six patients underwent immediate primary repairs. One patient with cervical knife stap wound died 4 hours postoperatively of hemoptysis, progressive hypoxia and aneuria, 6 of them were recovered with a normal patency of airway

The authors concluded that, result of treatment for tracheobronchial injury should depend upon the mechanism of injury, early recognition, early diagnosis and appropriate surgical intervention. Delay in diagnosis is the single most important factor-influencing outcome. Common complications in the early phase were hypoxia, organ failure while in the late phase were sepsis, tracheal or bronchial stenosis, mediastinitis and chronic bronchopleural fistula, etc.