Patiño-Gallegos H, Morales-Gómez J, Pinedo-Onofre JA, Miranda-Franco A

Language: Spanish
References: 14
Page: 124-127
PDF size: 88.52 Kb.

ABSTRACT

Introduction: Diagnosis of tracheobronchial tree rupture is difficult. It occurs as a consequence of high speed motor vehicle accidents. The aim of this work is to report a case of traumatic right main bronchus rupture, with late reimplantation. Clinical case: 24 year old female status post motor vehicle accident, rib fractures, bilateral pneumothorax, managed with bilateral closed thoracostomies and mechanical ventilatory support. Presented complete right lung atelectasis since day two which persisted and in spite of which the chest tubes were withdrawn on day 15, and she was discharged home. Atelectasis persisted three weeks later. A bronchoscopy confirmed complete obstruction of the right main bronchus. She underwent bronchial reimplantation through a right thoracotomy 45 days after the accident. Full lung expansion was achieved and follow-up at 10 weeks was without complications. Discussion: Late recognition and incorrect treatment of this kind of injuries increases mortality and morbidity. Dealing with chronic injuries, direct repair is indicated if lung parenchyma is not damaged, even months or years after the lesion.

REFERENCES

1. Roxburgh JC. Rupture of the tracheobronchial tree. Thorax 1987; 42(9): 681-688.

2. López EF, Zabalo M, Encinas M, Díaz Regañón G, Pagola MA, González Fernández C. Rotura bronquial en traumatismo torácico cerrado. Arch Bronconeumol 2000; 36(11): 651-654.

3. Gómez-Caro A, Ausín HP, Moradiellos Díez FJ, Díaz-Hellín V, Larrú CE, Pérez AJA, et al. Manejo médico-quirúrgico de las lesiones traqueobronquiales traumáticas no iatrogénicas. Arch Bronconeumol 2005; 41(5): 249-254.

4. Kiser AC, O’Brien SM, Detterbeck FC. Blunt tracheobronchial injuries: treatment and outcomes. Ann Thorac Surg 2001; 71(6): 2059-2065.

5. Barmada H, Gibbons JR. Tracheobronchial injury in blunt and penetrating chest trauma. Chest 1994; 106(1): 74-78.

6. Karmy-Jones R, Wood DE. Traumatic injury to the trachea and bronchus. Thorac Surg Clin 2007; 17(1): 35-46.

7. Symbas PN, Justicz AG, Ricketts RR. Rupture of the airways from blunt trauma: treatment of complex injuries. Ann Thorac Surg 1992; 54(1): 177-183.

8. Baumgartner F, Sheppard B, de Virgilio C, Esrig B, Harrier D, Nelson RJ, et al. Tracheal and main bronchial disruptions after blunt chest trauma: presentation and management. Ann Thorac Surg 1990; 50(4): 569-574.

9. Lampl L. Tracheobronchial injuries. Conservative treatment. Interact Cardiovasc Thorac Surg 2004; 3(2): 401-405.

10. Toker A, Tanju S, Dilege S. Reimplantation of the left lung 17 years after a bronchial rupture. Ann Thorac Surg 2008; 85(4): 1436-1438.

11. Maddali MM, Menon RG, Valliattu J. Traumatic bronchial rupture: implications of a delayed presentation. J Cardiothorac Vasc Anesth 2008; 22(6): 875-878.

12. Beale P, Bowley DM, Loveland J, Pitcher GJ. Delayed repair of bronchial avulsion in a child through median sternotomy. J Trauma 2005; 58(3): 617-619.

13. Narváez FS, Morales GJ, Ávalos BJA. Lesiones traumáticas del árbol traqueobronquial en el Instituto Nacional de Enfermedades Respiratorias. Estudio retrospectivo periodo 1998-2003, tesis de titulación de postgrado en Cirugía Cardiotorácica, Subdirección de Cirugía, Instituto Nacional de Enfermedades Respiratorias «Ismael Cosío Villegas», Octubre de 2006.

14. Grillo HC, Zannini P, Michelassi F. Complications of tracheal reconstruction. Incidence, treatment, and prevention. J Thorac Cardiovasc Surg 1986; 91(3): 322-328.