Conzo Giovanni, Fiorelli Alfonso, Palazzo Antonietta, Stanzione Francesco, Della Pietra Cristina, Santini Mario
General Surgery Unit, Second University of Naples, Italy.
Ann Ital Chir. 2012 Jan-Feb;83(1):55-8.
Tracheal rupture is a rare condition, and its most common cause is head and neck injury. Nontraumatic disruption of the anterolateral fibrocartilaginous trachea is an exceptional complication following thyroidectomy with few cases reported in literature. We report a case of upper tracheal necrosis arising 15 days after uneventful total thyroidectomy and resulted in pneumomediastinum and subcutaneous emphysema. The patient felt a sudden pop in his neck following an episode of vigorous coughing and experienced rapid swelling in his neck. The presence of pneumomediastinum was diagnosed on chest Computed Tomography scan and bronchoscopy visualized a small perforation on the right side of the anterolateral tracheal wall. The first interesting aspect is that several factors (female gender, thyrotoxic goiter, wound infection or excessive use of diathermy) reported as possible cause of anterior tracheal necrosis in the previous reports are unlike for the present case. The second unusual point is the spontaneous healing of the tracheal tear. Considering the no-critical ill condition of the patient and the size of the tear we decide for a conservative treatment rather than surgical repair. Finally, our report underlights that the presence of subcutaneous emphysema following thyroidectomy should alert the possible existence of tracheal rupture. The favourable outcome of our patient shows that small tracheal perforation due to tracheal necrosis may be successfully treated with conservative treatment.
气管破裂是一种罕见的病症，其最常见的病因是头颈部损伤。甲状腺切除术后前外侧纤维软骨性气管发生非创伤性破裂是一种罕见的并发症，文献中报道的病例很少。我们报告一例在甲状腺全切除术后15天出现的气管上段坏死病例，该病例导致了纵隔气肿和皮下气肿。患者在剧烈咳嗽后颈部突然出现爆裂感，并伴有颈部迅速肿胀。胸部计算机断层扫描诊断出纵隔气肿，支气管镜检查发现气管前外侧壁右侧有一个小穿孔。第一个有趣的方面是，先前报告中被认为可能是气管前壁坏死原因的几个因素（女性、毒性甲状腺肿、伤口感染或过度使用电刀）在本病例中并不存在。第二个不寻常之处是气管撕裂的自愈。考虑到患者病情不严重以及撕裂的大小，我们决定采取保守治疗而非手术修复。最后，我们的报告强调，甲状腺切除术后出现皮下气肿应警惕气管破裂的可能存在。我们患者的良好预后表明，因气管坏死导致的小气管穿孔可以通过保守治疗成功治愈。
