A warning of a rare complication-delayed tracheal rupture after thyroidectomy: a report of three cases

Thyroidectomy is a primary treatment for thyroid diseases, with low mortality but a 3-5% complication rate. Delayed tracheal rupture, though rare, is a life-threatening complication causing severe respiratory compromise and mediastinal infections. This case report of three post-thyroidectomy delayed tracheal ruptures shares clinical experiences to improve recognition, management, and preventive strategies.

Case 1: A 47-year-old male presented on postoperative day (POD) 5 with dyspnea and subcutaneous emphysema. Computed tomography (CT) confirmed tracheal wall disruption, which was managed surgically with muscle flap packing and prolonged drainage. Case 2: A 53-year-old female developed an irritating cough on POD 9. Imaging revealed tracheal cartilage defects, which were repaired via rotational muscle flap. Case 3: A 54-year-old female experienced rapid-onset stridor and septic shock on POD 2. Despite repeated interventions (thoracostomy, intensive care, and anti-infective therapy), she developed progressive pneumomediastinum and two tracheal fistulae, ultimately requiring surgical re-exploration and prolonged ventilator support. All cases required multidisciplinary management, with varying recovery timelines and outcomes.

Delayed tracheal necrosis carries significant morbidity and mortality risks. Prevention hinges on meticulous preoperative evaluation, intraoperative avoidance of tracheal vascular compromise and thermal injury, and heightened postoperative vigilance for warning signs like dyspnea or subcutaneous emphysema. Management should be tailored to severity, ranging from conservative measures to urgent surgical repair. Early multidisciplinary intervention, including aggressive infection control and airway stabilization, is critical to optimize outcomes in this high-stakes complication.