Summary
Background. Perforation of the trachea is a rare, but serious complication of endotracheal intubation, usually requiring emergency endoscopy and/or surgery. We present a case of iatrogenic tracheal perforation, which was managed without major surgical intervention. Case report. A 9 year-old-boy was scheduled for tonsillectomy under general endotracheal anaesthesia. The surgery lasted 5 minutes, after which the crying and struggling boy was extubated and transferred to the recovery area. A few minutes later we observed rapidly progressing subcutaneous emphysema and respiratory distress. The boy became cyanotic (SaO₂ 40%), and his heart rate decreased to 40 bpm. He was re-intubated with a small-bore endotracheal tube and transferred to the PICU. On admission, he had extensive subcutaneous emphysema of the head, neck, chest and hands; bilateral pneumothoraces; and pneumomediastinum. An X-ray showed the tip of the tube to be just above the carina. Thoracic and subcutaneous drains were inserted the endotracheal tube was withdrawn 2 cm cephalad and the cuff was emptied. The boy´s general condition rapidly improved. Bronchoscopy, performed after 7 days of conservative treatment, revealed a partially healed 2 cm tear in the tracheal wall, located 1 cm above the carina. The child was extubated 10 days after the accident and subsequently discharged home in a satisfactory condition. Discussion. Iatrogenic tracheal perforation may occur without obvious cause. In the described case, tracheal perforation probably occurred during manipulation of the patient´s head during surgery and was enlarged when the boy was struggling during the immediate postoperative period. A suitable response to initial resuscitation allowed for a rapid recovery without surgical intervention. We conclude that every case of damage to the tracheobronchial tree should be approached individually. Surgical intervention should be avoided where possible.