Delayed Tracheal Rent Following Total Thyroidectomy

Abstract

Tracheal injury associated with thyroidectomy is rare. We report the case of a 41-year-old lady who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. On postoperative day (POD) 8, she complained of cough followed by a ‘give-way’ sensation over her neck. On POD 10, she presented with dyspnoea after a sudden bout of cough with blood-tinged sputum, stridor and swelling over the surgical site. Computerised tomographic (CT) scan showed a defect on the right anterolateral wall of the trachea at the level of C6 vertebra and subcutaneous emphysema. She underwent emergency tracheostomy under general anaesthesia. Intraoperatively, a 5 mm × 10 mm tracheal rent was visualised between the first and second tracheal rings over the right side with surrounding unhealthy tracheal cartilages. The defect was closed with strap muscles and surgical tracheostomy performed between the 4th and 5th tracheal rings. In patients presenting with respiratory distress and subcutaneous emphysema following thyroid, mediastinal or anterior cervical approach surgery, a high index of suspicion of delayed tracheal injury must be entertained. An X-ray, and more importantly a CT imaging, may be conclusive to identify the site of tracheal rupture. The decision to follow conservative management or consider urgent surgery will depend on patient presentation.