successful treatment of tracheal stenosis by rigid bronchoscopy
- Home
- Documents
- Successful treatment of tracheal stenosis by rigid bronchoscopy
4
CASE REPORT Open Access Successful treatment of tracheal stenosis by rigid bronchoscopy and topical mitomycin C: a case report Jyi Lin Wong 1* , Siew Teck Tie 1 , Bohari Samril 2 , Chee Lun Lum 2 , Mohammad Rizal Abdul Rahman 3 , Jamalul Azizi Abdul Rahman 1 Abstract Tracheal stenosis is a known complication of prolonged intubation. It is difficult to treat and traditional surgical approach is associated with significant risk and complications. Recurrent stenosis due to granulation tissue necessi- tates repeated procedures. We describe a case of short web-like tracheal stenosis (concentric membranous stenosis less than 1 cm in length without associated cartilage damage) managed by a minimally invasive thoracic endo- scopic approach. Topical application of Mitomycin C, a potent fibroblast inhibitor reduces granulation tissue forma- tion and prevents recurrence. Introduction MacEwen first reported endotracheal intubation for anesthesia in 1880 [1]. Lindholm reported injuries to the larynx and trachea after intubation in 1969 [2]. Despite advancement and the use of high volume, low pressure cuffed tubes, tracheal stenosis is not an uncommon complication of endotracheal intubation. In one pro- spective study of critically ill patients, 11% of patients who were intubated with high volume, low pressure cuffed tubes developed tracheal stenosis [3]. Endotra- cheal tube causes pressure injury to the glottis and may result in severe commissural scarring that is difficult to treat. Although there have been reports of successful treat- ment of tracheal stenosis with steroid regimens [4,5], the mainstay of treatment for symptomatic lesions is surgical. Various surgical methods have been described including anterior cricotracheal splitting, laryngofissure creation with anterior lumen augmentation, resection or end-to-end anastomosis [6-8], but they are not without risks. Tracheal reconstruction requires major surgery, with a mortality of about 3% [9,10]. Rigid bronchoscopy with tracheal dilatation and stenting has been described as some of the treatment methods for less serious lesions [11]. Relapses are relatively frequent, making it the principal long-term problem with this method of treatment [12,13]. Case presentation A 30-year-old Malaysian woman who had bilateral upper lobe lung bullae underwent bullectomy in May 2008 for rapidly enlarging bullae causing respiratory compromise. Post-operatively, she was intubated for 6 days. Upon trial of extubation at day 6, she developed shortness of breath. She was re-intubated for another 5 days before extubation was successful and she was dis- charged 20 days post operatively. She was well for the next one month until July 2008 when she developed a sudden onset of shortness of breath and stridor. Intubation attempt with a 4 mm endotracheal tube was unsuccessful leading to emer- gency tracheostomy. Flexible bronchoscopy in the oper- ating room revealed a membranous web-like concentric stenosis without cartilage involvement 3 cm below the vocal cords. Bronchoscopy through the tracheostomy showed normal distal airways. A neck CT scan con- firmed the presence of a short segment tracheal stenosis (less than 1 cm) [figure 1]. In August 2008, she underwent rigid bronchoscopy using a 12 mm Dumon rigid tracheal tube. This was fol- lowed by examination using a small diagnostic flexible * Correspondence: [email protected] 1 Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia Wong et al. Cases Journal 2010, 3:2 http://www.casesjournal.com/content/3/1/2 © 2010 Wong et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Upload: others
Post on 12-Sep-2021
2 views
