Severe tracheal tear due to endotracheal intubation: a case report

Background: Tracheobronchial injury is a life-threatening condition with a considerable missed diagnosis rate. The larger the tracheal lesion the more difficult it is to heal. Both conservative and non-conservative treatments are used to treat tracheal injury. This article reports a clinical scenario in which conservative treatment was successfully used to manage a severe tracheal tear.

Case description: We present the case of a 63-year-old male with a cough for over a year who suffered from a 4-cm tracheobronchial injury (level IIIA, Cardillo classification) after endotracheal intubation for right lower bilobectomy. This injury showed full-layer tissue tearing of the tracheal wall, without esophageal injury or mediastinitis. The tracheal tear was discovered during the bronchoscopy examination on postoperative day one. The patient's vital signs were almost stable, including body temperature, blood pressure, heart rate, and oxygen saturation. We adopted a conservative treatment approach, including oxygen administration, painkillers, broad-spectrum antibiotics therapy, and nutritional support. Using this treatment, the 4-cm long tracheal rupture healed within four weeks. No tracheal tear was found in the bronchoscopy re-examination. The computed tomography scan showed that the mediastinal and subcutaneous emphysema had disappeared entirely. The patient fully recovered well without any complaints of discomfort.

Conclusions: Conservative treatment provides a valuable strategy for treating patients with massive tracheal lesions, representing an effective approach, especially in older patients with underlying diseases whose conditions are not suitable for operative treatments.