CRCM  Vol.3 No.6 , June 2014
Therapeutic Management in Proximal Tracheal Rupture during Total Thyroidectomy
ABSTRACT

Tracheal disruption is a life-threatening rare complication of total thyroidectomy that it should be prevented. The own-patient risk factors, procedure of tracheal intubation and a meticulous surgical technique are three main keys to keep in mind. Both medical and surgical management of this injury depends on its size, location and patient’s symptoms although neither of them prevents late complications. An early diagnosis could improve with prognosis although it is mandatory to perform either respiratory functional or imaging study in order to assume its healing. When the tracheal laceration is diagnosed during the surgery, we should take care with a continuous monitoring of the patient’s vital signs. A good oxygenation will be succeeded in high volume and low pressure with endotracheal tube distal to the lesion. We advice placing a tube drain near the disruption to prevent emphysema and an early extubation to avoid an ischaemic damage of the mucosa. A postoperative suspicion of tracheal rupture could demand reintubation with the patient in full relaxation and an examination by CT-scan or fiberscope before deciding a simple supportive therapy. We present our therapeutic experience in a female patient who suffered from tracheal injury during total thyroidectomy and describe a review of literature.


Cite this paper
Ovejero-Gomez, V. , Bermudez-Garcia, M. , Lamfus-Prieto, J. , Gallego-Bellido, T. , Villalba-Torre, J. , Ingelmo-Setien, A. and Bajo-Arenas, J. (2014) Therapeutic Management in Proximal Tracheal Rupture during Total Thyroidectomy. Case Reports in Clinical Medicine, 3, 382-386. doi: 10.4236/crcm.2014.36085.
References
[1]   Damrose, E.J. and Damrose, J.F. (2009) Delayed Tracheal Rupture Following Thyroidectomy. Auris Nasus Larynx, 36, 113-115.
http://dx.doi.org/10.1016/j.anl.2008.03.007

[2]   Vidal, M.C., Vázquez, E., Tercedor, A., Guzmán, E., Cuesta, P. and Galán, M. (2007) Conservative Management of the Airway Following Iatrogenic Rupture. Revista Espanola de Anestesiologia Reanimacion, 54, 246-249.

[3]   Satyadas, T., Nasir, N., Erel, E. and Mudan, S.S. (2003) Iatrogenic Tracheal Rupture: A Novel Approach to Repair and a Review of the Literature. The Journal of Trauma, 54, 369-371.
http://dx.doi.org/10.1097/01.TA.0000031940.95165.FE

[4]   Moschini, V., Losappio, S., Dabrowska, D. and Iorno, V. (2006) Tracheal Rupture after Tracheal Intubation: Effectiveness of Conservative Treatment. Minerva Anestesiologica, 72, 1007-1012.

[5]   Frova, G. and Sorbello, M. (2011) Iatrogenic Tracheobronchial Ruptures: The Debates Continues. Minerva Anestesiologica, 77, 1130-1133.

[6]   D’Odemont, J.P., Pringot, J., Goncette, L., Goenen, M. and Rodenstein, D.O. (1991) Spontaneous Favorable Outcome of Tracheal Laceration. Chest, 99, 1290-1292.
http://dx.doi.org/10.1378/chest.99.5.1290

[7]   Kara, H., Bayir, A., Ahmet, A.K., Tufekci, N., Degirmenci, S. and Akinci, M. (2013) Tracheal Rupture Developing after Blunt Thoracic Trauma. Case Reports in Clinical Medicine, 2, 502-504.

[8]   Barbetakis, N., Samanidis, G., Paliouras, D., Lafaras, C., Bischiniotis, T. and Tsilikas, C. (2008) Intraoperative Tracheal Reconstruction with Bovine Pericardial Patch Following Iatrogenic Rupture. Patient Safety in Surgery, 20, 4.
http://dx.doi.org/10.1186/1754-9493-2-4

[9]   Aydemir, B., Celik, S., Uncu, O., Tanrikulu, H. and Okay, T. (2013) Iatrogenic Tracheal Ruptures: Review of the Literature and Personal Experience on 11 Cases. Open Journal of Thoracic Surgery, 3, 130-134.
http://dx.doi.org/10.4236/ojts.2013.34027

[10]   Dreyfuss, D., Jackson, R.S., Coffin, L.H., Deane, R.S. and Shinozaki, T. (1986) High-Frequency Ventilation in the Management of Tracheal Trauma. The Journal of Trauma, 26, 287-289.
http://dx.doi.org/10.1097/00005373-198603000-00015

[11]   Jougon, J., Ballester, M., Choukroun, E., Dubrez, J., Reboul, G. and Velly, J.F. (2000) Conservative Treatment for Postintubation Tracheobronchial Rupture. The Annals of Thoracic Surgery, 69, 216-220.
http://dx.doi.org/10.1016/S0003-4975(99)01129-7

[12]   Deja, M., Menk, M., Heidenhain, C., Spies, C.D., Heymann, A., Weidemann, H., Branscheid, D., et al. (2011) Strategies for Diagnosis and Treatment of Iatrogenic Tracheal Ruptures. Minerva Anestesiologica, 77, 1155-1166.

[13]   Shain, M., Anglade, D., Buchberger, M., Jankowski, A., Albaladejo, P. and Ferretti, G.R. (2012) Case Reports: Iatrogenic Bronchial Rupture Following the Use of Endotracheal Tube Introducers. Canadian Journal of Anaesthesia, 59, 963-967.
http://dx.doi.org/10.1007/s12630-012-9763-z

[14]   Lobato, E.B., Risley 3rd, W.P. and Stoltzfus, D.P. (1997) Intraoperative Management of Distal Tracheal Rupture with Selective Bronchial Intubation. Journal of Clinical Anesthesia, 9, 155-158.
http://dx.doi.org/10.1016/S0952-8180(96)00241-3

[15]   Daitoku, K., Sakai, T., Yamada, Y., Tsushima, T., Koyoma, M. and Takaya, S. (2002) Succesfully Repaired Traumatic Tracheal Disruption and Cardiac Rupture with Cardiopulmonary Support. The Japanese Journal of Thoracic and Cardiovascular Surgery, 50, 70-73.
http://dx.doi.org/10.1007/BF02919668

 
 
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