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A right non-muscle-sparing posterolateral thoracotomy was performed through the fourth intercostal space. Following bronchoscopy, the endotracheal tube was advanced into left main bronchus. The patient was placed in the left lateral position with hips rotated at 45°, and the right femoral vessels were then isolated and taped. Therefore, in the interests of expeditious repair, the decision was taken to forego preparation of a muscle flap, and provisions were made for instituting emergency femoro-femoral cardiopulmonary bypass should cardiorespiratory complications occur intra-operatively. In addition, obesity and marginal premorbid functional status raised concerns regarding her ability to tolerate prolonged single-lung ventilation. The patient's critical preoperative state was of undifferentiated aetiology, and haemodynamic instability mandated vasopressor infusion support intra-operatively. The patient thus promptly proceeded to surgical repair. At repeat bronchoscopy, the defect was seen to open widely with each respirator delivered breath, and this was considered to pose significant risk of tube herniation and subsequent acute loss of airway and ventilation.
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The patient was transferred to our institution for definitive management. Computed tomography of the chest also revealed small volume pneumomediastinum. The lesion measured ∼6 cm and it extended to within ∼1.5 cm of the carina. Upon deflation of the cuff, there was a significant air leak in addition to haemoptysis and tracheal injury was suspected.īronchoscopy subsequently demonstrated a large posterior tracheal rupture in the pars membranosa. Right-main endobronchial intubation was noted on post-intubation chest X-ray, with the cuff displaced towards the right and grossly overinflated. On arrival in the emergency department of a regional hospital, orotracheal intubation was performed by a junior doctor on duty. Iatrogenic, Trachea repair, Bovine patch, Pericardium CASE PRESENTATIONĪ 67-year old female was found unresponsive at home, and her airway and ventilation were compromised.