Song Zhenghuan, Jiang Yueyi, Tan Jing, Gu Lianbing, Cai Jiaqin, Zhou Yihu
Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, PR China.
The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, PR China.
Heliyon. 2024 Mar 27;10(7):e28737. doi: 10.1016/j.heliyon.2024.e28737. eCollection 2024 Apr 15.
Tracheal injury is a rare but potentially serious acute complication of endotracheal intubation. Very few cases of tracheal injury associated with coagulation abnormalities have been reported in the literature. We present a rare case of a patient presenting with tracheal injury in combination with coagulation abnormalities following thyroidectomy.
A 58-year-old woman with a history of postoperative chemotherapy for breast cancer, gastric polyps, multiple colonic polyps, esophageal papillary adenomas, and thyroid adenomas presented with dyspnea following 10 ml hemoptysis on the third day after thyroidectomy; she was admitted to the intensive care unit and underwent tracheal intubation for maintaining the airway. Subsequent bronchoscopy revealed a nodular red neoplasm 5-cm from the carina in the trachea obstructing part of the lumen, with a small amount of fresh hemorrhage on the surface. Tracheal injury was considered the preliminary diagnosis. Fiberoptic bronchoscope guided tracheal intubation helped prevent rupture of the tumor, and the cannula was properly inflated to arrest the bleeding while blocking the lower part of the trachea. An emergency surgical evacuation of the cervical hematoma was performed for managing postoperative bleeding. The patient demonstrated persistent pancytopenia despite frequent transfusions. Laboratory examination results revealed abnormal coagulation parameters, anemia, and hepatic dysfunction. Following a multidisciplinary team discussion, pituitrin for hemostasis, tranexamic acid for strengthening hemostasis treatment, and nutritional support and anti-infection treatment were initiated. Endotracheal tube cuff inflation was performed to compress the bleeding site. Complete resolution of the subcutaneous hematoma was observed nine days after the tracheal injury; bronchoscopy revealed residual ecchymosis in the airway hematoma with no evidence of obstruction.
Conservative management of tracheal injury limited to the mucosa or submucosa without significant amount of active bleeding using endotracheal intubation is considered a practical and effective approach. Successful management was ensured by appropriate clinical suspicion, early multidisciplinary team discussion, and prompt diagnosis and interventions.
气管损伤是气管插管罕见但潜在严重的急性并发症。文献中报道的与凝血异常相关的气管损伤病例极少。我们报告一例甲状腺切除术后出现气管损伤合并凝血异常的罕见病例。
一名58岁女性，有乳腺癌术后化疗史、胃息肉、多发结肠息肉、食管乳头状腺瘤和甲状腺腺瘤病史，甲状腺切除术后第三天咯血10毫升后出现呼吸困难；她被收入重症监护病房并接受气管插管以维持气道。随后的支气管镜检查显示，气管内距隆突5厘米处有一个结节状红色肿物，阻塞部分管腔，表面有少量新鲜出血。初步诊断为气管损伤。纤维支气管镜引导下气管插管有助于防止肿瘤破裂，插管适当充气以止血，同时阻塞气管下部。为处理术后出血，紧急进行了颈部血肿手术清除。尽管频繁输血，患者仍持续全血细胞减少。实验室检查结果显示凝血参数异常、贫血和肝功能障碍。经过多学科团队讨论，开始使用垂体后叶素止血、氨甲环酸加强止血治疗以及营养支持和抗感染治疗。进行气管插管套囊充气以压迫出血部位。气管损伤九天后观察到皮下血肿完全消退；支气管镜检查显示气道血肿有残留瘀斑，无阻塞迹象。
对于仅限于黏膜或黏膜下层且无大量活动性出血的气管损伤，采用气管插管进行保守治疗被认为是一种实用且有效的方法。通过适当的临床怀疑、早期多学科团队讨论以及及时的诊断和干预确保了治疗的成功。
