Akutna respiratorna insuficijencija uzrokovana papilomatozom laringsa

Abstract

Recurrent respiratory papillomatosis is a rare disease, most commonly localized in the larynx. The prevalence is 1-4 diseased in every 100 000 people. It often starts in early childhood and is characterized by a chronic, recurrent and unpredictable development. Human papilloma virus type 6 and 11 is the cause of a disease that manifests itself with gradual development of hoarseness, vising, snoring dyspnea and a feeling of a strange body in the throat. A clinical picture of an acute respiratory insufficiency is shown, caused by recurrent respiratory papillomatosis. In March 2017. when the patient had experienced sudden choking, cyanosis, inspiratory stridor and trouble breathing. an urgent tracheotomy was conducted and tube no. 7 was reinforced in order to determine the level of obstruction from the larynx to the trachea. The patient was hospitalized in the department for intensive care, with an ensured airway and good saturation. Under anesthesia, a flexible bronchoscopy was used to remove a mucous cap from the trachea, after which a papillomatosis formation was seen at the entrance of the tracheostomy over the entire circumference of the lumen, which decreased the lumen to 15%. A consecutive mechanical recanalization was done with rigid tubes with the extraction of the papilloma with forceps. After the intervention, the trachea became transient up to 90% of the lumen. Patient is afterwards stable, soon released and has appeared for a checkup a month later, with satisfying results. This was his 55th hospitalization because of the primary disease. Repetition of tracheotomy increases the risk of spreading the infection into the trachea and lungs but is sometimes necessary due to unexpected life threatening situations in those suffering from papillomatosis in the larynx.