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Successful treatment of complicated tracheobronchial rupture using primary surgical repair

Ching-Yang Wu1, Tzu-Ping Chen, Yun-Hen Liu

  • 1Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei.

Chang Gung Medical Journal
|December 6, 2005
PubMed

Insights

Pediatric traumatic tracheobronchial disruption is a severe injury. Early diagnosis and surgical repair, like the end-to-end anastomosis described, improve patient outcomes and survival.

Area of Science:

  • Pediatric Surgery
  • Thoracic Trauma
  • Respiratory Medicine

Background:

  • Traumatic tracheobronchial disruption (TTD) is a rare but life-threatening injury in children.
  • Clinical presentation varies, necessitating a high index of suspicion and precise radiological interpretation for diagnosis.
  • Delayed treatment significantly elevates mortality and morbidity risks.

Observation:

  • A 9-year-old boy presented with respiratory failure, subcutaneous emphysema, bilateral pneumothorax, and pneumomediastinum.
  • Bronchoscopy confirmed a complex rupture at the right main upper lobar and intermediate bronchus junction.
  • The patient underwent emergent right posterolateral thoracotomy with bilateral chest tube insertion.

Findings:

  • End-to-end anastomosis of the disrupted bronchus was successfully performed using interrupted absorbable 4-0 vicryl sutures.
  • No pleural or muscle flap was used to cover the anastomosis.
  • Intra-operative bronchoscopy confirmed normal anastomotic integrity post-repair.

Implications:

  • This case highlights the successful management of pediatric TTD with prompt surgical intervention.
  • The described surgical technique achieved a good functional outcome with excellent airway patency at 6-month follow-up.
  • Effective management of TTD in children can lead to favorable long-term results and reduced complications.

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