Tracheal rupture due to endotracheal intubation after cesarean section: a case report

Document Type : Case report

Authors

1 Resident, Department of Anesthesiology, Student Research Committee, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.

2 Associate professor, Department of Anesthesiology, Clinical Research Development Unit of Rouhani Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.

Abstract

Introduction: Although spontaneous and traumatic tracheal rupture after intubation is rare, it is life-threatening. Common findings in the tracheal rupture after intubation are emphysema and respiratory distress. In this article, a patient with tracheal rupture due to intubation after cesarean section is introduced.
 Case presentation: A 37-year-old woman with 39-week gestational age underwent general anesthesia for cesarean section with tracheal tube No. 7. During the surgery, the patient was normal for hemodynamic status and respiration. At the end of the surgery after extubation of the tracheal tube, the patient experienced severe coughing. After transferring the patient to the recovery and reducing cough, the patient was transferred to the ward with an oxygen saturation of 96%. After about 30 hours of intubation, the patient suffered face swelling and mild respiratory distress, emphysema from the face to xiphoid. The amount of oxygen saturation with room air was 95% and respiratory distress was not evident. Hemodynamic status was stable. Computed tomography of the lungs showed pneumomediastin, pneumothorax, and subcutaneous emphysema of anterior chest wall and evidence of tracheal rupture. The patient was transferred to the Surgical Intensive Care Unit, and underwent conservative treatment. After 96 hours, emphysema was completely resolved and the patient was discharged from the hospital after 7 days with a good general condition.
Conclusion: Conservative treatment is recommended in tracheal rupture after intubation, when hemodynamic and respiratory conditions are stable.

Keywords


  1. Xu X, Xing N, Chang Y, Du Y, Li Z, Wang Z, et al. Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review. Int Wound J 2016; 13(2):268-71.
  2. Akbari H, Nasiri E, Ravanbakhsh E, Taghizadeh A, Nikkhah M, Mahdieh A. Post-intubation Tracheal Rupture Treated with Percutaneous Dilatational Tracheostomy. J Mazandaran Univ Med Sci 2014; 24(119): 206-212.
  3. Akkas M, Tiambeng C, Aksu NM, Onur R. Tracheal rupture as a result of coughing. Am J Emerg Med 2018; 36(11):2133.e1-2133.e3.
  4. Fiorelli A, Cascone R, Di Natale D, Pierdiluca M, Mastromarino R, Natale G, et al. Endoscopic treatment with fibrin glue of post-intubation tracheal laceration. J Vis Surg 2017; 3:102.
  5. Eliçora A, Akgül AG, Topçu S, Özbay S, Hoşten T, Sezer HF, et al. Management of Post-Intubation Tracheal Membrane Ruptures. Arch Iran Med 2016; 19(7):491-5.
  6. Hyeon Oh J, Jun Hong S, Soo Kang S, Mi Hwang S. Successful Conservative Management of Tracheal Injury After Forceful Coughing During Extubation: A Case Report. Anesth Pain Med 2016; 6(4):31:e39262.
  7. Invêncio da Costa LF, Alzate Amaya F, Barreto Calvo PC, González Poggioli N. Tracheal rupture after orotracheal intubation, based on a clinical case. Rev Esp Anestesiol Reanim 2019; 66(5):296-297.
  8. Schaeffer C, Galas T, Teruzzi B, Sudrial J, Allou N, Martinet O. Iatrogenic Tracheal Rupture Caused by Emergency Intubation: A Case Report. J Emerg Med 2018; 55(1):e15-e18.
  9. Vedovati S, Consonni F, Nacoti M, Bonanomi E. Severe postintubation tracheobronchial rupture. Paediatr Anaesth 2018; 28(5):471-473.
  10. Jones TS, Sullivan A, Damle S, Weyant MJ, Mitchell JD, Weitzel NS, et al. Assessment and Management of Post-Intubation Airway Injuries. Semin Cardiothorac Vasc Anesth 2017; 21(1):99-104.
  11. Bozzo C, Profili S, Masala S. Successful use of self-expandable metal stents in a case of iatrogenic tracheal rupture. Radiol Case Rep 2018; 14(3):377-380.
  12. Stouffs A, Scholtes JL. Intraoperatively diagnosed tracheal tear during a parathyroidec- tomy with previously undiagnosed tracheomalacia: a case report. Acta Anaesthesiol Belg 2016; 67(4):197-199.