The Diagnosis and Management of Patient with Delayed Symptoms from a Tracheal Tear

Abstract

Development of subcutaneous emphysema after gastrointestinal endoscopy with general anesthesia presents a diagnostic conundrum. We discuss the management of a patient who experienced significant vomiting followed by neck and facial swelling with crepitus and shortness of breath after the endoscopic retrograde cholangiopancreatography. The presence of respiratory distress usually suggests that head and neck subcutaneous emphysema is most likely associated with pneumothorax and/or pneumomediastinum. We discuss the prevention, differential diagnosis, and current management of tracheal tears including subcutaneous emphysema.

Systematic review of pneumothoraces after endoscopic retrograde cholangiopancreatography

“…In one rather peculiar case, a very late onset pneumothorax occurred, owing to a biliary stent dislocation and perforation in an intrathoracic herniated colon, which caused a colothoracic fistula [42]. Finally, three publications report-ed extra-intestinal causes, including a tracheal perforation [16] and a forced Valsalva manoeuvre [32,37].…”

“…In another two cases the perforation could not be identified at laparotomy [17,23]. In one case with a tracheal tear treatment consisted of stent placement and interposition of an intercostal muscle flap [16]. Finally, four publications did not report any details on the surgical intervention [14,21,22,35].…”