Complex bronchial ruptures in blunt thoracic trauma: management and outcome

Complex bronchial ruptures are rare. Primary surgical repair is the preferred procedure. The aim of this retrospective case series was to study the clinical presentation of these complex bronchial injuries and their management and outcomes. Patients with injuries to the trachea or those who had simple single bronchial rupture and isolated lobar and segmental injuries were excluded. Twenty-one patients were operated for bronchial rupture due to blunt chest trauma. Seven patients had complex bronchial injuries and had right bronchial tree injury (n = 3), left bronchial tree injury (n = 3), and rupture of both right and left main bronchi (n = 1). Fibreoptic bronchoscopy established the diagnosis in all patients. Postoperative complications included atelectasis in four patients (57%) and left recurrent laryngeal nerve paralysis (n = 1; 14.3%), and one patient required tracheostomy (14.3%). All patients had follow-up bronchoscopy 2 months later, which showed no stenosis or scar formation in any of the patients. We concluded that primary repair of complex bronchial injuries, with preservation of the normal functioning lung, is the preferred option as it carries favorable immediate- and long-term results.