Tracheal Perforation Research Articles

Minimally Invasive Enucleation of Esophageal Leiomyoma: Experience From a Single Institution.

Esophageal leiomyoma is a rare disease, most of which are benign, and endoscopic tumor removal surgery is a widely accepted treatment method. The two surgical approaches, laparoscopic andthoracoscopic,must be selectedand applied according to the tumor size and location. The study aimed to evaluate the results, feasibility, and appropriate approach of minimally invasive surgery to treat esophageal leiomyoma. Subjects and research methods: A retrospective study of 27 cases of patients who underwent endoscopic tumor removal surgery to treat esophageal leiomyoma at Cho Ray Hospital was conducted from January 2015 to April 2020. Demographic characteristics, clinical symptoms, surgical characteristics, and postoperative complications were recorded. A total of16 men and 11 women were included in the study, with an average age of 47.2 years (25-76 years). In total, 92.6% of patients had symptoms, the most common beingdysphagia (n = 19); however, 7.4% of patients still had no symptoms. Tumor removal through right thoracoscopic surgery was performed in 18 patients; the remaining nine patients were approached through laparoscopic intra-abdominal surgery. The median tumor size in all patients is 3.0 cm (2.0-5.0 cm), with the smallest tumor being 1.2 cm and the largest tumor being 8 cm.Postoperative histopathology shows esophageal leiomyoma in 100% of cases. Three cases (11.1%) of esophageal mucosal perforation and one case (3.7%) of tracheal perforation occurred during surgery. There was no case of death or suture leak after surgery. There was one case of postoperative gastroesophageal reflux that was treated successfully with medical treatment for two weeks. The average follow-up period was 21.4 months, with no deaths or recurrences during follow-up. Endoscopic surgery is a safe, minimally invasive method for esophageal leiomyoma removal, with laparoscopy used for tumors near the gastroesophageal junction and right thoracoscopic surgery for remaining tumors, ensuring quick patient recovery.

Association between septic shock and tracheal injury score in intensive care unit patients with invasive ventilation: a prospective single-centre cohort study in China

ObjectivesThere was no evidence regarding the relationship between septic shock and tracheal injury scores. Investigate whether septic shock was independently associated with tracheal injury scores in intensive care unit (ICU)...

Delayed tracheal perforation after thyroid surgery in patient with neck radiotherapy

Delayed tracheal perforation after thyroid surgery in patient with neck radiotherapy

Endotracheal Intubation via Tracheotomy and Subsequent Thoracotomy in Rats for Non-Survival Applications.

Endotracheal intubation and subsequent ventilation are often basic requirements for translational research in rat models for various interventions that require controlled or high ventilation pressures or access to the thoracic cavity and organs. Conventional endoorotracheal intubation using the anatomically existing route through the mouth is well suited for survival experiments. However, this procedure poses some challenges, including generally higher levels of the required experience and technical skill, more advanced equipment, and greater time effort with relevant intubation failure rates and complications such as tracheal perforation, temporary systemic hypooxygenation, and relevant aerial leakage. This manuscript, therefore, presents a detailed step-by-step protocol for endotracheal intubation through tracheotomy in non-survival rat models when guaranteed intubation success, constant oxygenation levels, high ventilation pressures, or open thoracotomy are required. The protocol emphasizes the importance of meticulous surgical technique to ensure consistent and reliable outcomes, especially for researchers who are inexperienced or lack routine in the technique of endoorotracheal intubation via direct laryngoscopy. This procedure is, therefore, expected to minimize animal suffering and unnecessary animal losses.

A foreign body complicated by tracheal perforation in the esophagus of a two-year-old child (clinical observation)

Foreign bodies in the gastrointestinal tract remain one of the significant problems in pediatric practice. Ingestion of foreign bodies is typical for children of all ages, but especially for the first 5 years of life. Due to the anatomical features of children, foreign bodies are often located at the level of the first physiological narrowing – in 68% of cases. The mortality rate from foreign bodies is 1%, but with the development of severe complications, this figure increases to 45%. A disc-shaped battery is the most dangerous one for health, as it is capable of causing local infiltrative-necrotic changes, perforation of the esophagus. Disc-shaped batteries as FB (foreign body) form up to 10% of the total number of foreign bodies of the gastrointestinal tract in children. Unfortunately, parents do not immediately seek medical help, since the symptoms indicating the presence of FB are often absent or may manifest as non-specific symptoms. Endoscopic examination serves as a key method in the diagnosis of ingested FB among children and its removal less than 24 hours after ingestion, since any delay reduces the probability of successful intraluminal extraction. This article discusses the clinical observation of a prolonged presence of a foreign body in the esophagus of a toddler child. The clinical course manifested itself in the form of nonspecific symptoms, a foreign body was detected only after a number of studies and was removed by endoscopic method. During the examination of the patient, in addition to the chest X-ray, esophagogastroduodenoscopy and a number of bronchoscopies were performed. Accessible and highly informative methods of instrumental diagnostics available in each clinic of the regional scale, today remain the first stage of the diagnosis of foreign bodies.

Tracheal perforation after total thyroidectomy

Tracheal perforation after total thyroidectomy

Delayed Tracheal Perforation After Thyroidectomy: A Case Report and Literature Review.

Thyroidectomy is a safe procedure that is frequently performed for benign or malignant thyroid disease. Complications after thyroidectomy occur in approximately 3%-5% of patients. Tracheal perforation is a very rare post-thyroidectomy complication, and delayed tracheal perforation without intraoperative tracheal injury is even rarer; only 25 case reports have been published globally, with varied management. We present the case of a 36-year-old man presenting with dyspnea and cough 2weeks after left thyroidectomy. A defect measuring approximately 2cm was confirmed on the anterior wall of the trachea by computed tomography and flexible laryngoscopy. The patient's symptoms improved with conservative treatment including systemic steroids, and surgical treatment was not required. Even in the absence of unusual intraoperative events, delayed tracheal necrosis and perforation should be considered as possible postoperative complications following thyroidectomy.

Patient with neck swelling.

An approximately 70-year-old female with a history of anaplastic thyroid cancer with metastasis to the lungs and cervical spine presented to the emergency department with a new fluctuant neck swelling of approximately 1 week's duration (Figure 1, Video 1). The mass was non-tender but oscillated paradoxically with respirations. The patient also noted a mildly hoarse voice. One month previously, she underwent total radical thyroidectomy with extensive soft tissue resection, including cricotracheal resection with primary re-anastomosis. The patient underwent computed tomography with contrast of the neck. (Figure 2). The computed tomography revealed a large, predominantly air-filled collection in the anterior neck measuring 7 × 6 × 6 cm and communicating with a contained tracheal perforation. The patient was taken to the operating room the following day, confirming breakdown of the cricotracheal repair. The patient underwent debridement and revision tracheostomy. Tracheal dehiscence is the complete disruption of the tracheal wall. This is in contrast to tracheal diverticulum, which represents an outpouching of the tracheal wall.1, 2 Anastomotic dehiscence occurs in 2.5%–11% of postoperative patients.3, 4 Known risk factors for dehiscence include diabetes and laryngotracheal resections, as well as long resections, pediatric age group, preoperative tracheostomy, and tension on the anastomosis. The current case is unusual in the timing of the diagnosis (1 month after surgery) and the large size of the perforation.5, 6 Surgical complications of tracheal repair may occur in up to 27% of patients. Bilateral recurrent nerve palsy is the most common complication. Other potential complications include anastomotic dehiscence, hypoparathyroidism, glottic edema, anastomotic stenosis, bleeding, respiratory insufficiency, and ventilator dependency.7, 8

Delayed tracheal perforation post total thyroidectomy

Delayed tracheal perforation is a rare occurrence post thyroidectomy. We present a 72 year-old female patient that underwent elective total thyroidectomy and right upper parathyroidectomy, with bilateral central lymph node dissection and modified radical neck dissection. The post-operative period was complicated by high-risk pre-morbid status and multiple failed extubations, in addition to ischaemic tracheal areas visualised on the bronchoscopy on post-operative day (POD) 8, with subsequent computerised tomography (CT) scan showing anterior neck collections and perforation. A tracheal perforation involving the anterolateral wall (2nd and 3rd rings) was repaired surgically, followed by a tracheostomy. Suspicion of tracheal injuries should always be considered if patient fail to liberate from the mechanical ventilation post-operatively, warranting prompt conservative and/or surgical management. Potential devascularisation, secondary to diathermy-induced injury and pressure exerted by endotracheal tube cuff onto already weakened/friable trachea, should be considered as probable aetiological factors.

A clinical case of intraoperative tracheal injury during endoscopic transaxillary hemithyroidectomy

Тhis article describes a clinical case of a rare complication during transaxillary endoscopic thyroidectomy. The causes of intraoperative tracheal perforation, the patient management tactics, as well as the measures to prevent this complication, are analyzed on a specific example.

A Rare Complication: Tracheal Laceration after Routine Intubation at the Tamale Teaching Hospital

Patients Tracheal perforation is a rare complication of endotracheal intubation that usually presents as a linear lesion in the membranous wall of the trachea. It is more prevalent in women (because they have shorter stature and a weaker pars membranosa compared to men), patients 50 years and older and patients less than 160 cm tall. Most common clinical manifestations includesubcutaneous emphysema, pneumomediastinum, pneumothorax, respiratory distress and haemoptysis. We report the case of a young male presenting with tracheal perforation after routine endotracheal intubation. This case was managed conservativelywithout complications. Possible causes for the injury include: over-inflation of the endotracheal tube cuff, intubation by an inexperienced anaesthetist or use of an inappropriately sized tube for the patient. Clinical suspicion must be followed by diagnostic confirmation, which was achieved by direct visualization of trachea rupture on bronchoscopy. We therefore encourage endotracheal tube cuff pressure monitoring during general anaesthesia and direct supervision of an inexperienced anaesthetists during critical events such as induction and intubation.

Obstructive shock due to tracheal perforation following long-term placement of a tracheostomy tube in a pediatric patient: a case report

BackgroundTracheal perforation, although rare, is a known late complication of tracheostomy tube placement.Case presentationWe present a 7-year-old boy with severe physical and mental disabilities under tracheostomy and long-term mechanical ventilation and steroid therapy who suddenly developed obstructive shock secondary to pneumomediastinum and pneumothorax. Prior bronchoscopy had shown the tip of the tracheostomy tube contacting the posterior tracheal wall, causing ulceration and subsequent tracheal perforation. The perforation was bridged using a cuffed tracheostomy tube, but the patient subsequently died of additional comorbidities.ConclusionsOur experience suggests that tracheal perforation should be considered when pediatric patients with tracheostomy tubes suddenly develop hypotension.

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

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.

Trachea features and fiber dimensions of fast-growing tree: A case study on wood samples from eastern Indonesia

Fast-growing plant is one of the characteristics of pioneer plants. Commonly, the plants grow in areas that is exposed to sunlight such as open area and forest edges. Fast-growing plants have different anatomical and physical wood characteristics compare with slow-growing plants. Therefore, this study aims to examine the anatomical characteristics of fast-growing plants, especially trees, namely the fiber cells and trachea features. A total of 33 wood samples from 28 species were used in this study. We used wood samples from Eastern Indonesia deposited at Herbarium Bogoriense. Examined wood samples are taken from branches with 1-2 cm of diameter. The anatomical characters observed were focused on two types of cells, namely fiber cells (fiber length, fiber diameter, fiber cell wall thickness, lumen width, identification of septate fibers and fibers pit) and the trachea (perforation type, pit arrangement, and pit form). From the observations of all wood samples showed that the length of fiber cells are classified as short (18 species) and medium (10 species) fiber. There are two groups of fiber cell wall thickness viz. very thin (16 species) and thin to thick (12 species). Septate fibers only found in 7 species especially Chisocheton and Teijsmanniodendron. Fiber’s pit observed in Horsfieldia parviflora, Mallotus peltatus, dan Neuburgia corynocarpa. All species have simple tracheal perforation with alternate or opposite pit arrangement. Moreover, branch wood samples have polygonal pit shape, oval or combination of those two shapes were found in some species, such as Horsfieldia parviflora, Sandoricum koetjape and Teijsmanniodendron bogoreinse.

Diagnosis and surgical repair of delayed tracheal perforation post thyroidectomy in context of previous cranio-spinal radiotherapy - A case report.

Introduction and importanceThis is the first case of delayed tracheal perforation post total thyroidectomy in the context of previous radiotherapy to the neck. Such a presentation can be easily misdiagnosed and managed as a seroma at significant risk to the patient, as the latter had no precipitating factors and cardiorespiratory compromise. There are nineteen previously described cases of delayed tracheal injury post thyroidectomy of variable severity and variable intervention.Case presentationA 51-year-old man presented with non-tender anterior neck surgical emphysema initially diagnosed on bedside ultrasound and plain X-ray, 22 days following total thyroidectomy and central neck dissection. His background was significant for childhood acute lymphoblastic leukaemia requiring chemotherapy and cranio-spinal radiotherapy. He underwent total thyroidectomy, for multiple bilateral thyroid nodules found on cranio-spinal MRI surveillance concerning for follicular neoplasm. There were significant amount of adhesions tethering the thyroid secondary to prior radiotherapy but no tracheal injury intra-operatively.Clinical discussionAt presentation, no source of air leak was identified on Computer Tomography. He failed conservative management. During surgical exploration, a 2 mm tracheal perforation at the right cricothyroid joint was closed with the right sternothyroid muscle due to the proximity of the perforation with the recurrent right laryngeal nerve. Tisseel was applied over the repair. He recovered without further complications.ConclusionSudden onset neck swelling post thyroidectomy in the context of significant scaring from radiotherapy, should raise the suspicion of surgical emphysema in the neck patients and confirmed with plain x-ray. Such patients should have multidisciplinary tertiary care.

갑상선절제술 후 발생한 기관 천공과 종격동기종 1예

Tracheal injury is a rare complication of thyroid surgery, with a reported incidence of 0.06%. Subcutaneous emphysema or pneumomediastinum may occur due to tracheal perforation, which is manifested by symptoms such as intense cough, neck and facial swelling, dyspnea, hemoptysis, and retrosternal pain. So far, there have been no domestic reports of cervical subcutaneous emphysema or pneumomediastinum caused by tracheal perforation during thyroid surgery. We would like to report a case of a 44-year-old female who experienced complete recovery only with conservative treatments after cervical and mediastinal emphysema due to tracheal perforation during thyroid surgery. (J Clinical Otolaryngol 2021;32:312-316)

갑상선절제술 한 달 후 발생한 기관천공 1예

Tracheal perforation after thyroidectomy is a rare complication and it requires prompt attention due to the risk of compromised airway. We present a case of a 52-year-old female patient who underwent total thyroidectomy due to papillary thyroid carcinoma. One month after the operation, anterior neck swelling and subcutaneous emphysema developed. Small tracheal perforation was revealed on computed tomography scan and bronchoscopy. The patient recovered uneventfully after a conservative treatment by inserting a venous catheter into the subcutaneous emphysema and applying negative pressure for seven days. Here, we report this case with a review of the literature. (J Clinical Otolaryngol 2021;32:317-321)

Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units.

ABSTRACTBackgroundPercutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs.Patients and methodsThis randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc™ sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc™ sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure.ResultsProcedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes (p <0.001)] and mean blood loss [group-M: 5.33 ± 1.69 mL; group-F: 6.87 ± 3.11 mL (p = 0.001)] was significantly less in group-M. Higher incidence of desaturation [group-M: 16.7%; group-F: 35% (p = 0.022)] was noted in group-F, whereas arrhythmias [group-M: 21.7%; group-F: 6.7% (p = 0.018)] were higher in group-M. There was no statistical difference in incidence of pneumothorax and subcutaneous emphysema. There was no incidence of posterior tracheal wall perforation in any of the patients.ConclusionMini-surgical technique is a faster alternative of FOB-guided PCDT with comparable incidence of complications. It can safely be used in intensive care units (ICUs) where FOB is not available.Clinical trial registration numberCTRI/2018/05/014307Name of registryClinical Trials Registry of India (CTRI), URL—http://ctri.nic.in How to cite this articleKumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units. Indian J Crit Care Med 2021;25(11):1269–1274.

Stent-in-stent technique for removal of the tracheal stent in patients with severe granulation tissue hyperplasia

A tracheal stent implantation is an effective treatment for benign or malignant tracheal stenosis and tracheal fistula (1-6). Currently, covered self-expanding metal stents (SEMS) are generally used in benign cases and uncovered SEMS for treating malignant tracheal stenosis. However, the radial force of the stent on the trachea and the friction between the stent and the tracheal wall during coughing often provoke granulation tissue hyperplasia (7,8). This hyperplasia, which appears at the ends of covered stents or over the entire stented area in the case of uncovered stents, results in incarceration of the stent and tracheal restenosis (9,10). Removal of the stent is then necessary (11,12). Tracheal stent removal can result in complications such as a tracheal mucosal tear, tracheal perforation, mediastinal abscess, massive hemorrhage, and asphyxia (13-15). When the SEMS is embedded in hyperplastic granulation tissue, tracheal perforation and hemorrhage risks are especially high (16-18). Despite advances in interventional techniques and bronchoscopy, both stent removal and treatment of related complications remain difficult. Inspired by the success of the stent-in-stent (SIS) technique for esophageal stent removal (19,20), we applied it to the removal of tracheal SEMS in four patients with severe proliferative stenosis. We describe our technique and report the outcomes.

THYROID ABSCESS: A CASE SERIES

Thyroid abscess is a rare surgical pathology, accounting for less than 0.7% of surgical pathologies involving the thyroid 1,2 gland. This is due to its rich blood supply and lymphatic drainage, high concentration oodine that inhibits bacterial growth, protective brous capsule, and fascial planes 2–4 separating it from other neck structures. It may lead to complications like septicaemia, paralysis of the vocal cords, retropharyngeal abscess and suppurative media stinitis and 2 may occasionally lead to osteomyelitis or septic thrombophlebitis. It 5 may also lead to tracheal and oesophageal perforation. The 6 left lobe is commonly affected. If left untreated, thyroid abscess can be life threatening resulting in a mortality of 12% 6 or more