Transmediastinal Trachea Closure after Dilational Tracheotomy Positioned Too Low Down

Area of Science:

• Medicine
• Surgery
• Pulmonology

Background:

• Percutaneous dilational tracheotomy (PDT) is a minimally invasive technique for long-term mechanical ventilation.
• Complications can arise, necessitating prompt and effective management.

Purpose of the Study:

• To report a rare complication of PDT and its successful surgical management.
• To emphasize the importance of anatomical considerations in tracheotomy procedures.

Main Methods:

• A case report of a 70-year-old male patient undergoing PDT.
• Management involved bronchoscopy, video mediastinoscopy, and surgical repair of a tracheal defect.
• Conventional tracheotomy was performed after defect closure.

Main Results:

• The patient experienced tracheal cannula dislocation nine days post-PDT.
• Recannulation was not possible due to cannula malposition and anatomical challenges (grade 3 goiter, short neck).
• Surgical repair of the tracheal defect and subsequent conventional tracheotomy successfully restored mechanical ventilation.

Conclusions:

• Complex anatomical factors can complicate PDT and its management.
• Surgical intervention, including mediastinoscopy and defect repair, may be necessary for managing PDT complications.
• Conventional tracheotomy remains a viable option when PDT fails or leads to complications.