Spontaneous tracheal rupture in a 1-year-old child

Abstract

Abstract Spontaneous tracheal rupture is a rare phenomenon in the pediatric population, however it is a potentially fatal condition; necessitating discussion surrounding controversies of investigation and management. We report a case of an 18-month-old presenting with bilateral pneumothoraces, a pneumomediastinum and dysphagia, with review of the literature. The referring unit inserted one intercostal drain into the left hemithorax despite a chest radiograph demonstrating significant bilateral pneumothoraces. On arrival in our unit the child was in respiratory distress with subcostal recessions, tachypnoea, and bilateral decreased breath sounds. He saturated at 75% on room air and improved to 100% when placed onto polymask oxygen. Subcutaneous emphysema was palpable on both sides of his neck, his chest, and anterior abdominal wall. An intercostal drain was inserted on the right side, improving his respiratory distress. Analgesia and prophylactic antibiotics were prescribed. A contrast swallow was performed to exclude an oesophageal injury, which showed no leak. A Computerized Tomography scan revealed a tear in the membranous trachea posteriorly, from the level of the third thoracic vertebral body extending into the left main bronchus. The patient responded well to conservative management with face-mask oxygen, gentle chest physiotherapy and dietary supplementation. The child never required intubation and did not develop sepsis during his admission. His cough was suppressed with codeine phosphate. On day 10, the chest drains were removed and the child was discharged home 11 days after admission. On follow-up, the child was worked up for complaints of gastro-oesophageal reflux disease. A repeat contrast swallow and oesophageal biopsies confirmed the diagnosis and the child was treated with a laparoscopic Nissan fundoplication and gastrostomy after failure of appropriate medical therapy. No adverse respiratory events have been encountered.