The authors report a tracheal rupture in a 34-year-old patient who was primarily intubated following generalised seizures and loss of consciousness (Rüsch endotracheal tube). Some hours later, she developed high ventilatory airway pressures and subcutaneous and mediastinal emphysema were noted. Reintubation with a high-volume, low-pressure endotracheal tube was planned when it was noted that the ballon of the Rüsch tube was grossly overinflated. Endotracheal tube cuff pressure was measured and found to be greater than 120 cm H2O (the maximum measurement possible with the manometer). The diagnosis of tracheal rupture was confirmed by fiberoptic bronchoscopy. The patient immediately underwent a throactomy and a 3-cm tear of the pars membranacea of the trachea was sutured with a dural patch. To maintain low airway pressures post-operatively, she remained sedated for 2 days and received a muscle relaxant to permit pressure-controlled ventilation. In this case, it can be concluded that excessive inflation of the endotracheal tube cuff resulted in the tracheal rupture. Other possible causes and results of tracheal rupture are discussed.

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Organic hyperinsulinism is rare: the incidence is 1:100,000. In newborns, often of diabetic mothers, there may be islet cell hyperplasia. Rare cases may require partial pancreatectomy. In adults, the condition is always due to an insulinoma.

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