Complete transection of the intrathoracic trachea due to blunt trauma

A 24-year-old man was transferred to Columbia-Presbyterian Medical Center from a local hospital 24 hours after a car crash. Bronchoscopy at the local hospital revealed transection with discontinuity of the trachea just above the carina. At Columbia-Presbyterian Medical Center, following cautious intubation without positive airway pressure, a right posterolateral thoracotomy was performed, and the bronchi were intubated with sterile endotracheal tubes for initial airway control. A 6-cm tracheal disruption was repaired. Early care was complicated by chest wall instability and pulmonary contusions, but the patient was discharged breathing comfortably on the tenth postoperative day. Subsequent to discharge, flow-volume loops revealed the development of a tracheal stricture. Three months after the initial procedure, tracheal resection for stenosis was completed. To date, the patient is asymptomatic.