Elsevier

The Annals of Thoracic Surgery

Volume 86, Issue 3, September 2008, Pages 1020-1022
The Annals of Thoracic Surgery

Case report
Successful Repair of a Subtotal Rupture of Distal Tracheobronchial Tree With Complete Abridgment of the Right Bronchus in a 4-Year-Old Child

https://doi.org/10.1016/j.athoracsur.2008.02.095Get rights and content

Accurate diagnosis of tracheobronchial injuries in children is difficult due to the paucity of clinical presentation and the variety of clinical symptoms. They are potentially life threatening in blunt chest trauma. We report here on a clinical case of a boy who was injured during outdoor activity. We describe intraoperative findings of the massive tracheobronchial lesion and its successful repair using a pericardial patch technique and postoperative recovery. Such a serious tracheobronchial injury with a positive outcome has not been reported so far. Clinical and technical steps are described and discussed.

Section snippets

Comment

We report here on the management of a traumatic dissection of the right main bronchus and subtotal rupture of the tracheal bifurcation in a child. Tracheobronchial ruptures describe any injury between the cricoid cartilage and the bronchioli. Their cause includes iatrogenic mechanisms, blunt chest trauma, penetrating wounds, avulsion, and explosive injuries. Frequency in children is difficult to assess. In the more recent literature the incidence varies between 0.7% and 2.8%. The male-female

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    The main indication for surgery were persistent air leak from the chest tube and associated respiratory failure or shock. Progressing subcutaneous emphysema may also occur [18,24,20,11]. Bronchoscopy is recommended for early diagnosis and treatment, despite the possibility of misdiagnosis.

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    This procedure is not always necessary.26 When the airway is severed, surgical repair by suture/anastomosis7,27–30 or segmental or lobar resection may be necessary. A multi-centre study from nine French hospitals over 26 years collected 16 cases of blunt airway injuries in children, of which half were tracheal and half bronchial.

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