Tracheal Perforation Caused by Too Deep Suture during Thyroidectomy: a Case Report and Literature Review

Abstract

Tracheal perforation is a rare complication in thyroidectomy and intubation. The anesthesiologist needs more experience to make a timely diagnosis of tracheal perforation. However, there is little literature that discuss the intraoperative tracheal perforation. This article describes an unexpected tracheal perforation during thyroidectomy and reviews literature about risk factors, symptoms, and tracheal management. Case presentation — A 66-years-old female patient who was diagnosed with recurrent multinodular goiter, was planned to undergo subtotal thyroidectomy. When surgeon sutured the remain organ of thyroid, the anesthesiologist heard the air leakage near the trachea while the ventilator not showing insufficient ventilation. To find the damage position, appropriate saline that could cover the tracheal was injected into the surgical wound. Inflated the endotracheal tube cuff and some small bubbles emerged from a suture. The suspect that the damage was caused by over deep suture was confirmed, which tightly bonded the wall of the trachea with the cuff. Conclusions — In a word, for the surgery near-tracheal, the purpose of this case report was to recommend observe patient's condition more carefully, instead of simply relying on ventilator monitoring. In addition, if resistance is encountered during the extubation, the tube should not be blindly violently extubated.