Tracheal Perforation Caused by Too Deep Suture during Thyroidectomy: a Case Report and Literature Review

Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v3i1.708

Zhuolin Jia1, Yanyan Feng1, Huanliang Wang1, Lishuang Liang2

1. Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
2. Department of Painology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China

Abstract

Tracheal perforation is a rare complication in thyroidectomy and intubation. The anesthesiologist needs more experience to make a timely diagnosis of tracheal perforation. However, there is little literature that discuss the intraoperative tracheal perforation. This article describes an unexpected tracheal perforation during thyroidectomy and reviews literature about risk factors, symptoms, and tracheal management. Case presentation — A 66-years-old female patient who was diagnosed with recurrent multinodular goiter, was planned to undergo subtotal thyroidectomy. When surgeon sutured the remain organ of thyroid, the anesthesiologist heard the air leakage near the trachea while the ventilator not showing insufficient ventilation. To find the damage position, appropriate saline that could cover the tracheal was injected into the surgical wound. Inflated the endotracheal tube cuff and some small bubbles emerged from a suture. The suspect that the damage was caused by over deep suture was confirmed, which tightly bonded the wall of the trachea with the cuff. Conclusions — In a word, for the surgery near-tracheal, the purpose of this case report was to recommend observe patient's condition more carefully, instead of simply relying on ventilator monitoring. In addition, if resistance is encountered during the extubation, the tube should not be blindly violently extubated.

Keywords

anesthesia, endotracheal intubation, tracheal perforation, thyroidectomy

References

[1]Tartaglia N, Iadarola R, Di Lascia A, Cianci P, Fersini A, Ambrosi A. What is the treatment of tracheal lesions associated with traditional thyroidectomy? Case report and systematic review. World J Emerg Surg. 2018, 13:15.
[2]Gosnell JE, Campbell P, Sidhu S, Sywak M, Reeve TS, Delbridge LW. Inadvertent tracheal perforation during thyroidectomy. Br J Surg. 2006, 93(1):55-56.
[3]Xu X, Xing N, Chang Y, Du Y, Li Z, Wang Z, et al.Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review. Int Wound J. 2016, 13(2):268-271.
[4]Bertolaccini L, Lauro C, Priotto R, Terzi A. It sometimes happens: late tracheal rupture after total thyroidectomy. Interact Cardiovasc Thorac Surg. 2012, 14(4):500-501.
[5]Mazeh H, Suwanabol PA, Schneider DF, Sippel RS. Late manifestation of tracheal rupture after thyroidectomy: case report and literature review. Endocr Pract. 2012, 18(4):e73-76.
[6]Lee HC, Yun MJ, Goo EK, Bahk JH, Park HP, Jeon YT, et al. Rupture of endotracheal tube cuff during robot-assisted endoscopic thyroidectomy -A case report. Korean J Anesthesiol. 2010, 59(6):416-419.
[7]Heavrin BS, Hampson S, Stack LB. Tracheal perforation after thyroidectomy. J Emerg Med. 2012, 43(4):e259-260.
[8]Windon MJ, Dhillon V, Tufano RP. Case report: presentation of delayed tracheal perforation after hemithyroidectomy. AME Case Rep. 2018, 2:24.
[9]Joshi M, Mardakh S, Yarmush J, Kamath H, Schianodicola J, Mendoza E. Intraoperatively Diagnosed Tracheal Tear after Using an NIM EMG ETT with Previously Undiagnosed Tracheomalacia. Case Rep Anesthesiol. 2013, 2013:568373.

Copyright © 2022 Zhuolin Jia, Yanyan Feng, Huanliang Wang, Lishuang Liang

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