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Behavioral Disturbance Causing Sudden Respiratory Distress in a 3-Year-Old After Tracheocutaneous Fistula Closure: A
Rhashedah A Ekeoduru1, Hassan M Aijazi, Amy D Graham-Carlson
1From the Department of Pediatric Anesthesiology, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, McGovern Medical School, Houston, Texas.
Insights
A child developed severe subcutaneous emphysema, pneumothorax, and pneumomediastinum after a tracheocutaneous fistula repair. Emergency re-intubation and tracheostomy were required to manage this critical airway complication.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Tracheocutaneous fistulas can arise after tracheostomy, necessitating surgical repair.
- Postoperative complications following such procedures require vigilant monitoring, especially in pediatric patients.
Observation:
- A 3-year-old boy developed agitation and distress post-fistulectomy.
- Rapidly progressing subcutaneous emphysema involving the chest, face, and abdomen was observed.
Findings:
- Emergent orotracheal intubation was performed due to airway compromise.
- Chest radiography confirmed pneumothorax and pneumomediastinum, indicating significant air leakage.
- The patient required re-operation for tracheostomy tube placement.
Implications:
- This case highlights the potential for severe airway complications after tracheocutaneous fistula repair.
- Prompt recognition and intervention are crucial for managing post-surgical emphysema and related respiratory distress.
- Reinforces the importance of careful airway management in pediatric patients with a history of tracheostomy.
Abstract:
A 3-year-old boy underwent tracheostomy at age 5 months for respiratory failure. The tracheostomy tube was removed a year later but a tracheocutaneous fistula developed requiring fistulectomy and primary skin closure. After an initial uneventful course in the postanesthesia care unit, the patient became agitated, began to scream, and suddenly developed rapidly progressing subcutaneous emphysema over his chest, face, and abdomen. Orotracheal intubation was emergently performed and chest radiograph revealed pneumothorax and pneumomediastinum. The child was taken to the operating room for placement of a tracheostomy tube.