Journal Article

Management of membranous tracheal rupture due to the endotracheal tube cuff during thyroid surgery/ Tiroid cerrahisi esnasinda endotrakeal tup kafina bagli gelisen membranoz trakeal rupturun yonetimi

Alci, Erman, Sahin, Azad Gazi

2024

Overview

Tracheobronchial ruptures can be extremely dramatic and life threatening and are encountered in approximately 5 out of 100,000 cases after orotracheal intubation. They can occur as a result of intubation, tracheostomy, and bronchoscopy. In this case report, we presented a 56-year-old female patient with a history of thyroid surgery 27 years prior who presented to our clinic with recurrent multinodular goiter. The patient underwent a complementary complication-free thyroidectomy assisted by intermittent intraoperative nerve monitoring. After hemostasis, final controls involving digital palpation of the possible remnants of the thyroid gland and a search for pathological lymph nodes in the central compartments, a mass structure with a rubbery consistency suspicious for residue thyroid tissue was palpated in both posterolateral aspects of the trachea, but more prominently in the left. The anesthesia team was asked to decrease the cuff pressure, assuming that the palpated mass could be the cuff of the endotracheal tube, and the mass was noted to shrink. The membranous tracheal rupture due to the endotracheal tube cuff was closed with sutures running superiorly, and a superiorly based strap muscle flap was placed over during thyroid surgery. The patient was discharged on day 7. A simple routine digital examination by the attending surgeon dealing with the thyroid surgery would contribute favorably to prognosis, as such a precaution would allow early repair in cases where such injuries occur. Keywords: Endotracheal tube cuff; thyroidectomy; tracheal rupture. Balikesir Universitesi Tip Fakultesi, Genel Cerrahi Ana Bilim Dali, Balikesir, Turkiye Trakeobronsiyal ruptur son derece dramatik ve yasami tehdit edici olabilir ve orotrakeal entubasyon sonrasi yaklasik 100.000 vakanin 5'inde gorulur. Entubasyon, trakeostomi ve bronkoskopi sonucunda meydana gelebilir. Bu olgu sunumunda 27 yil once bir tiroid cerrahisi gecirmis olan ve klinigimize nuks multinoduler guatr sebebiyle basvuran 56 yasinda bir kadin hastayi sunduk. Aralikli intraoperatif sinir monitorizasyonu esliginde tamamlayici tiroidektomi operasyonu komplikasyonsuz olarak uygulanan hastada hemostaz sonrasinda, olasi rezidu tiroid dokusu ve santral kompartmanlarda olasi patolojik lenf nodlarinin parmak palpasyonu ile aranmasini iceren son kontroller sirasinda solda daha belirgin olmak uzere trakeanin her iki posterolateralinde rezidu tiroid dokusu oldugundan suphe edilen lastik kivaminda kitle yapisi palpe edildi. Palpe edilen kitlenin endotrakeal tupun kafi olabilecegi dusunulerek anestezi ekibinden endotrakeal tup manson basincinin dusurulmesi istendi ve manson basincinin dusurulmesiyle birlikte palpe edilen kitlenin kuculdugu gozlendi. Endotrakeal tup mansonunun neden oldugu membranoz trakeal ruptur suturlerle kapatildi ve uzerine superior bazli strap kas fleb ile rekonstruksiyon uygulandi. Hasta 7. gun saglikla taburcu edildi. Tiroid cerrahisi ile ugrasan cerrahlar tarafindan ameliyat sonunda yapilacak basit bir rutin dijital muayene bu tur yaralanmalarin meydana geldigi durumlarda erken onarima izin verecegi icin prognoza olumlu katkida bulunacaktir. Anahtar sozcukler: Endotrakeal kaf; trakeal ruptur; tiroidektomi.

• Publisher: KARE Publishing
• Subject: Surgeons