Case report: video-assisted thoracoscopic repair of right main bronchus transection after blunt chest injury

Abstract

Background Traumatic tracheobronchial injury is a rare manifestation after blunt chest injury. The current standard treatment has wide spectrum from conservative treatment to open thoracotomy with repair airway regarding to severity of the disease. However, to the best of our knowledge, no one has reported airway repair in trauma using video-assisted thoracoscopic surgery (VATS) before. Hence, we describe the successful management and repair of a transected right main bronchus using VATS. Case Description A 43-year-old male patient presented with chest tightness after a traumatic blunt chest injury; a chest computed tomography revealed multiple rib fractures and suspected right main bronchus injury with large pneumomediastinum and subcutaneous emphysema. Although the current standard treatment is to perform open thoracotomy with tracheal repair, we performed VATS repair of right main bronchus in purpose to reduce the stress from tissue trauma and minimally invasive fashion. Emergency surgery was scheduled for injury repair, and the transected right main stem bronchus and mediastinum hematoma were intraoperatively identified. The right main bronchus was repaired using polypropylene 4-0 interrupted sutures under uniportal VATS and covered with pericardial fat pad tissue. After the surgery, the patient had no air leak from chest tube drainage and recovered well. The patient was performed diagnostic bronchoscopy to confirm the patent airway at day 3 then discharged 7 days after surgery and was doing well at a 1-month follow-up. Conclusions VATS repair is safe and feasible as an alternative approach to conventional thoracotomy approach in the treatment of traumatic tracheobronchial injury.

Management of tracheobronchial ruptures in blunt chest trauma: pushing the boundaries towards a minimally invasive surgical approach

“…In a recent issue of AME Case Reports , Yu and Laohathai [2023] reported on a case of a middle-aged male patient with a right main bronchus injury after blunt chest trauma ( 1 ). After diagnostics in the form of chest radiography and computed tomography (CT) scan, the patient underwent immediate surgical treatment using a minimally invasive video-assisted thoracoscopic surgery (VATS) approach.…”

“…The treatment modality of choice strongly depends on the patient’s condition and the extent of the bronchial injury ( 12 , 13 ). Cardillo et al [2010] proposed a morphological classification of bronchial injuries to guide non-surgical or surgical treatment ( 4 ), however this classification was based on post-intubation tracheal injuries and has not been validated to guide therapeutic choices for traumatic bronchial injuries such as described in Yu and Laohathai ( 1 ).…”

“…Furthermore, multiple organ injuries might impede proper patient stabilization, meaning that the duration of surgery in trauma patients may negatively affect outcome. Additionally, the operating field might be ill-defined due to injuries in the area that is being operated on ( 1 , 23 ). Hence, it is suggested that one should weigh the possible benefits and consider the drawbacks reported for trauma patients when considering VATS, even via an uniportal approach, for traumatic tracheobronchial repair.…”