Surgical treatment of bronchial rupture in blunt chest trauma: a review of literature

Roozendaal, Lori M. van; Gool, Matthijs H. van; Sprooten, Roy T.M.; Maesen, Bart; Poeze, Martijn; Hulsewé, Karel W. E.; Vissers, Yvonne L. J.; Loos, Erik R. de

doi:10.21037/jtd.2018.08.22

Cited by 30 publications

(31 citation statements)

References 36 publications

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“…Empyema is associated with elevated morbidity and mortality, around 20% to 30% of patients affected will either die or required further surgery in the first year after developing empyema, putting early and thorough intervention at the epicenter of each empyema case [9]. Contingent upon the origins of the infection, is it community-acquired or hospital-acquired, the bacteriology of empyema may change.…”

Section: Discussionmentioning

confidence: 99%

Occurrence and Management of Empyema Thoracis During Covid-19 Times

Christina¹,

Thrasyvoulos²,

Nikoleta³

et al. 2020

SCR

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Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by purulent fluid or the presence of bacterial organisms. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures and dreaded complications while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period in Greece, between March-June of 2020 due to COVID-19, in ameliorating those issues. Patients and Methods: During the aforementioned period 12 patients were treated at our Department, 11 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion from a bacterial pneumonia in 10 patients and the other 2 were tuberculous empyema and extension of an intraabdominal process (Diffuse large B-cell lymphoma of the stomach). Predominately the patients were admitted to our Department with stage III empyema. Diagnosis was confirmed with CT scan and drainage of frank pus from the chest tube. All patients underwent chest tube insertion and antibiotic therapy nonetheless 9 of them required surgical management with VATS or open decortication. Results and Conclusion: The impedance in seeking medical advice due to fear of COVID-19 and the insufficiency of an interdisciplinary approach in the management of those patients were determined as the reason for such high admittance with stage III empyema. The decision of open vs VATS decortication was made based on the medical status and history of each individual, the stage of the empyema and ultimately our ability to achieve the two primary goals of empyema treatment, complete evacuation, and lung reexpansion [1]. Eight patients underwent open decortication and drainage and one managed with VATS decortication. Postoperative complications were encountered in 3 patients which included prolonged air leak, surgical wound infection, and septic shock. One patient died from multiple organ failure due to postoperative septic shock. The duration of chest tube drainage varied from 5-15 days. The mean hospital stay was 13,5 days.

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Section: Discussionmentioning

confidence: 99%

Occurrence and Management of Empyema Thoracis During Covid-19 Times

Christina¹,

Thrasyvoulos²,

Nikoleta³

et al. 2020

SCR

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“…Thoracotomy and primary anastomosis without further measures are the main surgical approach for tracheobronchial injury in children 2 and adults. 8 Both running or interrupted sutures are used, according to the literature. 2 8 9 Risk factors for anastomotic leakage include inadequate suture pitches, discrepancy of the bronchial diameter, high tension on the anastomosis, and poor visualization of the operative field.…”

Section: Discussionmentioning

confidence: 99%

“…8 Both running or interrupted sutures are used, according to the literature. 2 8 9 Risk factors for anastomotic leakage include inadequate suture pitches, discrepancy of the bronchial diameter, high tension on the anastomosis, and poor visualization of the operative field. 9 Intercostal muscle flap, 8 suture holders, 9 or bronchial plication of the membranous portion of the bronchus in cases of discrepancy of the bronchial diameter 10 may be used to reduce the risk of complication in a stable patient.…”

Section: Discussionmentioning

confidence: 99%

Emergency Repair of an Isolated Traumatic Avulsion of the Right Main Stem Bronchus in a 7-Year-Old Girl

König¹,

Wittenmeier

Muensterer³

2019

European J Pediatr Surg Rep

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Introduction Isolated tracheobronchial injury after blunt trauma of the chest is rare. Because of the high elasticity of the chest in children, they occur mainly in the pediatric population. Case Report We report a case of a 7-year-old girl who experienced complete avulsion of the right main bronchus at the level of the carina after a horse-riding accident. The patient presented with extensive emphysema of the upper chest, neck, and face and severe respiratory distress. Endotracheal intubation led to tension pneumothorax. After insertion of two 17-mm thoracostomy tubes, pneumothorax and a massive air leak persisted. Isolated central bronchial injury was confirmed by computed tomography of the chest. Bronchoscopically guided selective intubation of the left main stem bronchus failed and the patient desaturated, requiring immediate salvage right posterolateral thoracotomy. Simultaneous occlusion of the defect, stabilization, and subsequent selective left lung intubation was possible only after placing a suture at the tracheal rim of the defect for retraction allowing compression of the defect and keeping the lumen open at the same time. Conclusion A cluster of clinical signs with subcutaneous emphysema and refractory pneumothorax with air leak of the thoracotomy tube is indicative of bronchial injury. Endotracheal intubation should be postponed in these cases until after thoracostomy tube placement, if possible. Placing a retraction suture during repair is a maneuver that helps to occlude the defect and keep the remaining tracheobronchial lumen open at the same time to establish crucial ventilation of the contralateral lung.

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“…Literature data is consistent, that 75-90% of TBIs in blunt trauma are located within 2-3 cm from the carina and 60% of them are within 1 cm (13,14,48,52). The majority of data states that the main bronchi are most frequently injured (66-85%), especially the right side (27-61%) (14,48,53,55,56).…”

Section: B Location Size and Classification Of Tbimentioning

confidence: 81%

“…The majority of patients with TBI are involved in high-velocity car-, or a motor accidents. Other injuries include falling from height, crush trauma, or pedestrian accidents (43,48). Blunt trauma is responsible for TBI in approximately 94% of cases in children, while penetrating injuries are more frequent in adults (49,50).…”

Section: Discussion a Epidemiology Of Tbimentioning

confidence: 99%

Clinical consideration of some rare emergency thoracic cases in pediatric surgery

Rieth

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Background: Tracheobronchial injuries are rare but feasibly life-threatening conditions. A prompt diagnosis and early management can be lifesaving. Due to the unspecific symptoms and indirect radiological signs the diagnosis often delays.Objectives: We present a short series of patients suffering from tracheobronchial airway laceration. All the three patients had blunt thoracic or neck trauma and showed early signs of tracheobronchial injury. In the first case a 44-year-old woman was crushed by a bus. Subcutaneous emphysema, pneumothorax on chest computed tomography and hypoxaemia despite of chest tube suggested the presence of an airway injury. During operation a 4-cm-long tear of the trachea and a complete transection of the right main bronchus were found. In the second case a 12-year-old girl was crossed by a truck trailer. Early signs were respiratory failure, extended subcutaneous emphysema, blood clot in the larynx, pneumothorax on both sides. Chest CT showed pneumomediastinum. During the operation a longitudinal laceration was found separating the two main bronchi at the bifurcation. In the third case a 9-year-old boy was injured in a car accident, when the seat-belt crossed his neck. Spreading subcutaneous emphysema, pneumomediastinum and an overinflated endotracheal tube's cuff were found on CT. A completely transected trachea between the first and second tracheal rings was found. All three patients required fast intubation and bronchoscopic examination to confirm the diagnosis, and to identify the site of lacerations. All the patients underwent primary reconstruction and recovered successfully. Conclusions:In case of suspected tracheobronchial injury, a high index of suspicion is required for early diagnosis. Most commonly respiratory distress, subcutaneous emphysema and pneumothorax are found on physical examination. Prompt intubation below the site of the injury and early laryngo-or bronchoscopic examination have priority, as we did in our cases. A primary anastomosis is required with minimal resection during urgent operation. A better outcome is to be expected when extubation is done early after surgery. We offer ordinal steps that should be taken to lead to a prompt management and good long-term outcome based on the literature and our experiences.

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Surgical treatment of bronchial rupture in blunt chest trauma: a review of literature

Cited by 30 publications

References 36 publications

Occurrence and Management of Empyema Thoracis During Covid-19 Times

Occurrence and Management of Empyema Thoracis During Covid-19 Times

Emergency Repair of an Isolated Traumatic Avulsion of the Right Main Stem Bronchus in a 7-Year-Old Girl

Clinical consideration of some rare emergency thoracic cases in pediatric surgery

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