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Delayed complication of tracheocutaneous fistula closure with severe compromising subcutaneous emphysema

Robert J Lewis1, Ari G Mandler2, Geovanny Perez3,4

  • 1Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

BMJ Case Reports
|June 24, 2019
PubMed

Insights

A rare complication of subcutaneous emphysema and pneumomediastinum occurred after tracheocutaneous fistula excision. This case highlights effective management and lessons learned for TCF closure.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Thoracic Surgery

Background:

  • Tracheocutaneous fistula (TCF) can persist after decannulation in trẻ em.
  • Surgical excision with secondary intention is a management option for persistent TCFs.

Observation:

  • A 4-year-old boy with a persistent 3 mm TCF underwent excision and closure by secondary intention.
  • Postoperatively, the patient developed significant subcutaneous emphysema and pneumomediastinum.

Findings:

  • The patient was extubated after 2 days and discharged on postoperative day 7.
  • Complete resolution of subcutaneous emphysema and TCF closure were observed at follow-up.

Implications:

  • This case underscores the potential for serious complications following TCF excision.
  • Effective management strategies for subcutaneous emphysema are crucial in TCF treatment.
  • Lessons learned can inform future surgical approaches and patient care for TCFs.

Keywords:
head and neck surgeryotolaryngology / ENTpaediatric intensive carepaediatricspneumomediastinum

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