Recurrent airway obstructions in a patient with benign tracheal stenosis and a silicone airway stent: a case report

PC Robinson,KB Sriram

doi:10.1186/1757-1626-1-226

Abstract

Airway stents (silicone and metal stents) are used to treat patients with benign tracheal stenosis, who are symptomatic and in whom tracheal surgical reconstruction has failed or is not appropriate. However airway stents are often associated with complications such as migration, granuloma formation and mucous hypersecretion, which cause significant morbidity, especially in patients with benign tracheal stenosis and relatively normal life expectancy. We report a patient who had frequent critical airway obstructions over 8 years due to granuloma and mucus hypersecretion in a silicone airway stent. The problem was resolved when the silicone stent was removed and replaced with a covered self expanding metal stent.

Highlights

Benign tracheal stenosis secondary to prolonged intubation and/or tracheostomy has been treated by airway stenting in selected patients1
Benign tracheal stenosis is most often caused by prolonged intubation and/or tracheostomy. 67–90% of patients who are intubated develop laryngotracheal injury and 12–14% develop tracheal stenosis [3]
Symptomatic benign tracheal stenosis is optimally treated by tracheal reconstruction surgery [4]

Summary

Background

Benign tracheal stenosis secondary to prolonged intubation and/or tracheostomy has been treated by airway stenting in selected patients. Covered SEMS, such as the UltraflexTM stent (Boston Scientific, Massachusetts, USA) are more biocompatible and some reports suggest fewer complication rates compared with silicone stents. We report a patient who developed major complications with a Dumon® stent which were ameliorated when it was replaced by an UltraflexTM stent. Afterwards a 12 mm × 40 mm Dumon® silicone stent was inserted This stent was complicated by frequent obstructions due to granulation tissue and mucous plugs. Emergency bronchoscopy revealed extensive granulation tissue and mucous plugging within the Dumon® stent. In Nov 2007 she presented with severe respiratory distress and bronchoscopy revealed that the Dumon® stent had moved proximally (Figure 1) with granulation tissue in the distal end (Figure 2) causing 90% obstruction in midtrachea. The patient has remained asymptomatic since, with no further episodes of airway obstruction

Discussion

Findings

10. Food and Drug Administration