外科と麻酔のジャーナル

概要

Isolated Bronchial Injury: A Diagnostic and Management Challenge

Ashwani Kumar Dalal, Usha Rani Dalal, Virender Saini and Dheeraj Kapoor

Injuries to the trachea or major bronchi in high-speed motor vehicle accidents are mostly accompanied by fatal pulmonary contusion, vascular injury, abdominal injury, head injury, spine injury, and orthopaedic injury. Isolated major bronchial injury without any other major organ or vascular injury in blunt chest trauma is a rare entity. In most of these cases, the trauma may be trivial but sudden compression of chest leads to isolated tracheo-bronchial disruption. The diagnosis and management approach depends upon the existence and severity of other injuries. Cause of concern in a missed or delayed diagnosis is high mortality due to tension pneumothorax and significant morbidity due to progressive respiratory failure because of continuous major air leaks and/or debilitating chronic complications (persistent pneumothorax, atelectasis, fibrosis, pneumonitis, and empyema). Prompt diagnosis, skilful airway management along with early surgical intervention can greatly reduce the morbidity and mortality. The present retrospective study is over a period of eleven years (2004-2015). The demographic data including the aetiology, clinical features, radiological, bronchoscopic and operative findings were compiled from the records. A total of five cases, all males were diagnosed with major bronchial injuries. One case was diagnosed within 8 h, one was diagnosed after 48 h and in these cases primary repair was done. In three cases, diagnosis was made after 3 weeks and delayed repair was done. The average hospital stay was 21 days and follow up was 6 months. The clinical presentation and outcome stress the key role of early diagnosis and timely surgical intervention.