Department of Pediatrics, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
Pediatric Surgery Service, Department of Pediatrics, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal.
BMJ Case Rep. 2023 Jun 12;16(6):e254494. doi: 10.1136/bcr-2022-254494.
A girl was brought into the emergency room after a non-penetrating cervical trauma. On physical examination, a rapidly progressing chest subcutaneous emphysema was denoted. The child was immediately intubated and mechanical ventilation was initiated. The CT-scan revealed a rupture to the posterior wall of the trachea and a pneumomediastinum. The child was transferred to the paediatric intensive care unit. A conservative approach was chosen, including tracheal intubation as a bypass through the tracheal injury, sedation to reduce the risk of further tracheal trauma and prophylactic antibiotic therapy. Twelve days after the incident, a bronchoscopy demonstrated the integrity of tracheal mucous and the child was successfully extubated. Three months after hospital discharge she was asymptomatic. In this clinical case, the conservative approach presented a successful outcome, avoiding the risks associated with surgery.
一名女孩因非穿透性颈部外伤被送往急诊室。体格检查发现进行性加重的胸部皮下气肿。患儿立即行气管插管并启动机械通气。CT 扫描显示气管后壁破裂和气胸。患儿被转至儿科重症监护病房。选择了保守治疗方法，包括通过气管损伤进行气管插管作为旁路、镇静以降低进一步气管创伤的风险和预防性抗生素治疗。事件发生后 12 天，支气管镜检查显示气管黏膜完整，患儿成功拔管。出院后 3 个月，她无症状。在这个临床病例中，保守治疗方法取得了成功的结果，避免了手术相关的风险。
