Extensive Surgical Emphysema in a Child after Primary Closure of Tracheocutaneous Fistula

Abstract

A 4-year-old child had closure of tracheocutaneous fistula under general anaesthesia. He developed extensive surgical emphysema over the face, chest, and upper abdomen immediately in the recovery room. We gave him oxygen supplementation, removed surgical stitch, and inserted a 4 mm tracheostomy tube to secure airway. Chest X-ray ruled out pneumothorax or pneumomediastinum. After a week, a tight bandage was applied which approximated the tissue and helped in the closure of stoma; no suture was applied. The patient was discharged home on the fourth postoperative day. The patient needs close observation in the postoperative period with likely complication in mind. Recognizing early signs and symptoms of respiratory distress with quick intervention is lifesaving during the complication of tracheocutaneous fistula surgery. In absence of pneumothorax or pneumomediastinum, extensive surgical emphysema occurring during primary closure of tracheocutaneous fistula can be treated without inserting any drainage tube.

Tracheocutaneous Fistula After Tracheostomy: Spotlight on a Closure Technique With a High Success Rate

“…However, on postoperative day one, two patients (9.5%) developed subcutaneous emphysema and required reopening of the tract. These two patients were both smokers, had minor fistulae (12 and 20 mm2), and had a rubber band drain implanted during surgery [ 17 ].…”