Ulus Travma Acil Cerrahi Derg. 2022; 28(1): 120-123 | DOI: 10.14744/tjtes.2020.81613

Airway management of major blunt tracheal and esophageal injury: A case report

Kemalettin Koltka¹, Zerrin Sungur¹, Mehmet Ýlhan², Ali Fuat Kaan Gök², Emre Sertaç Bingül^1
1Department of Anesthesiology, Ýstanbul University Ýstanbul Faculty of Medicine, Ýstanbul-Turkey
²Department of General Surgery, Ýstanbul University Ýstanbul Faculty of Medicine, Ýstanbul-Turkey

Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesiologists to deal with. About 25% of post-traumatic deaths are due to thoracic traumas in which blunt injuries take a rather small place within and the resultant damage of respiratory tract is quite rare with an incidence of 0.5–2%. A recent review from a single trauma center revealed an incidence of 0.4% for tracheobronchial injury (TBI) due to blunt thoracic injuries. Most of the patients having tracheal transection lose their lives on the field due to loss of airway. Patients mostly present with a large spectrum of clinical features varying from hoarseness to respiratory collapse; though subcutaneous emphysema is the most common presenting sign which should remind possible TBI. Emergent surgery is preferred seldomly; such in cases of partial damage or because of late diagnosis, due to favorable outcome of conservative approach. Herein, we report the management of a case on TBI due to blunt thoracic trauma, experiencing difficult ventilation despite tracheal intubation. Fiber-optic bronchoscope (FOB) seems obligatory to visualize site and severity of injury and to ensure safe airway during procedures such as the neck exploration, primary end-to-end anastomosis of the trachea, tracheostomy, diversion pharyngostomy, and feeding jejunostomy.

Keywords: Blunt thoracic trauma, fiberoptic bronchoscope; injuries of trachea.

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Majör künt trakeal ve özofagus hasarýnda havayolu yönetimi: Olgu sunumu

Kemalettin Koltka¹, Zerrin Sungur¹, Mehmet Ýlhan², Ali Fuat Kaan Gök², Emre Sertaç Bingül^1
1Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Anesteziyoloji Anabilim Dalý, Ýstanbul
²Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

Trakeanýn transeksiyonel yaralanmalarý oldukça nadirdir ve bu durumla anestezistlerin baþa çýkmasý zor olabilir. Künt travmalarýn içinde oldukça küçük bir yer kaplayan toraks yaralanmalarý, travma sonrasý ölümlerin %25’ini oluþturmaktadýr. Bunun sonucunda ortaya çýkan solunum yolu hasarý %0.5–2 oranýnda görülür. Tek bir travma merkezinden yakýn zamanda yapýlan bir çalýþmada, künt toraks yaralanmalarý nedeniyle trakeobronþiyal hasar insidansý %0.4 olarak saptanmýþ. Trakeal transeksiyonu olan hastalarýn çoðu, hava yolu kaybý nedeniyle olay yerinde hayatýný kaybeder. Hastalar çoðunlukla, ses kýsýklýðýndan solunum kollapsýna kadar deðiþen klinik özellik yelpazesine sahiptir. Derialtý amfizem olasý trakeobronþiyal hasarý (TBH) düþündürmesi gereken en yaygýn bulgudur. Konservatif yaklaþýmýn olumlu sonuclarý nedeniyle acil cerrahi giriþim nadiren tercih edilir. Künt toraks travmasýna baðlý trakeobronþiyal yaralanma sonrasý trakeal entübasyona raðmen zor ventilasyon kliniðine sahip bir vakanýn yönetimini sunuyoruz. Bu hastalarda fiberoptik bronkoskop (FOB), bölgeyi ve yaralanmanýn ciddiyetini göstermek ve boyun eksplorasyonu, trakeanýn primer end-to-end anastomozu, trakeostomi, faringostomi ve beslenme jejunostomisini sýrasýnda güvenli hava yolunu saðlamak için zorunlu görünmektedir.

Anahtar Kelimeler: Fiberoptik bronkoskop, künt toraks travmasý; trekea yaralanmasý.

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