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Management of Large Tracheal Injury with Carinal Stent

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posted on 18.07.2022, 18:29 authored by Mohammad Aladaileh, Rachel Brown, Donna Eaton

A sixty-year-old woman—postesophagectomy—developed respiratory failure, surgical emphysema, and bilateral pneumothoraces. Bilateral chest drains were inserted into the patient. Next, a bronchoscopy procedure was performed; it initially showed a tracheal tear. Subsequently, a double-lumen endobronchial tube was inserted. Finally, the patient was transferred to a facility as an emergency case.

Procedure

The patient was evaluated under general anesthesia using a 14 mm rigid bronchoscope. There was a large tracheal tear in the posterior wall. Correspondingly, a flexible bronchoscopy was used with direct vision to inspect the tear. The position of the carina was marked fluoroscopically, and guidewires were placed down on both main bronchi. 

A bifurcated stent (16x50 mm) was inserted over the guidewires in a way that ensured it was covering the whole defect. The longer limb was advanced down the left bronchus, while the shorter limb was advanced down the right bronchus. Next, the bifurcation of the stent was advanced under fluoroscopic and bronchoscopic guidance to the carina. The stent was then deployed, and satisfactory position was confirmed. The air leak significantly decreased bilaterally.

Three months later, the patient was electively admitted for stent removal. By using a rigid bronchoscope, the edge of the stent was cored up, and forceps were used to remove it. The membranous tracheal tear healed completely. After three days, the patient was discharged from the facility uneventfully.

References

1. Lyons JD, Feliciano DV, Wyrzykowski AD, Rozycki GS. Modern management of penetrating tracheal injuries. Am Surg. 2013;79(2): 188-193.

2. Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of tracheobronchial Injuries: a contemporary teview. Chest. 2019;155(3):595–604. doi:10.1016/j.chest.2018.07.018

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