Acute airway obstruction associated with granulation tissue of tracheostoma--a case report

We report an 85-year-old tracheostomized male patient who underwent ventriculoperitoneal shunt because of hydrocephalus. Postoperative acute airway obstruction and tension pneumothorax developed due to the granulation tissue of tracheostoma which scraped off from the tracheostoma in the act of endotracheal intubation for operation and it lay dormant around until it was drawn into the endotracheal tube (ETT) by negative pressure during suction of trachea in intensive care unit. Persistent hypoxemia in consequence of airway obstruction resulted in cardiac arrest and expiratory seal of trachea eventuated in tension pneumothorax. Flexible fiberoptic bronchoscopy performed during resuscitation disclosed that the obstruction was due to granulation tissue which blocked the ETT lumen. Immediate exchange of endotracheal tube and placement of chest tube made the patient tide over this crisis. No sequela resulted from this crisis and the patient was discharged one week later.