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[Tracheo-bronchial fissures from external trauma in children. Apropos of 3 cases]
Insights
Pediatric tracheal tears from external trauma can cause significant respiratory distress. Early tracheobronchial endoscopy is crucial for diagnosing these injuries and guiding non-operative management in stable children.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Pulmonology
Background:
- External trauma to the trachea in children can cause severe injuries.
- Tracheobronchial tears present with gaseous syndrome, emphysema, and potential pneumothorax.
Purpose of the Study:
- To evaluate the role of tracheobronchial endoscopy in diagnosing and managing pediatric tracheal and bronchial membrane tears.
- To determine the appropriateness of non-operative treatment for these injuries.
Main Methods:
- Case series of three children (ages 3, 5, and 10) with external tracheal trauma.
- Symptomatic resuscitation followed by tracheobronchial endoscopy.
- Non-operative management for diagnosed tracheobronchial lesions.
Main Results:
- Endoscopy confirmed tracheal tears in all three cases, with varying locations (cervical trachea, thoracic trachea, stem bronchi).
- All patients experienced uncomplicated non-operative post-operative courses.
- Subcutaneous and mediastinal emphysema were noted, with one case complicated by pneumothorax and pneumomediastinum.
Conclusions:
- Tracheobronchial endoscopy is recommended for diagnosing pediatric tracheal contusions to precisely define lesions.
- Non-operative management is effective for stable pediatric patients with diagnosed tracheobronchial lesions.
- Early diagnosis and assessment via endoscopy guide therapeutic decisions, often avoiding surgery.
Abstract:
The authors report three cases of tears in the tracheal or bronchial membrane in children resulting from an accidental external trauma of the trachea. Those children ranged from 3, to 5 and 10 years old. Those lesions showed a clinical gaseous syndrome associated with mediastinal and subcutaneous emphysema, in one of these cases complicated by unilateral pneumothorax and pneumomediastinum. After a symptomatic resuscitation, tracheobronchial endoscopy gives evidence each time of a crack of the posterior face of the trachea = cervix trachea in one case, end of the thorax trachea in the two other cases. Among them one was injured at the stem bronchi. These tracheobronchial lesions were treated nonoperatively and had a post-operative course uncomplicated. The author's attitude--except in case of extreme urgency--in front of a severe, isolated cervix thorax contusion in children, is to give systematically the indication for tracheobronchial endoscopy, in the view of knowing whether there is a tracheobronchial lesion or not and, if so, to five precisions about its location, its anatomic size, and its type (tear, fracture, disruption). An endoscopy performed immediately after cardiorespiratory rebalancing imposes the therapeutic conduct to be adopted, which is not always operative. Such is the case for the authors, especially in the case of children for whom the diagnosis of tracheobronchial lesion is sure, and in whom the stability of the vital signs are doubtless. In such cases, one is imposed not to operate.(ABSTRACT TRUNCATED AT 250 WORDS)