Major Bronchial Trauma in the Pediatric Age Group

Abstract

Tracheobronchial injuries are rare among all age groups and are extremely rare among the pediatric age group. Yet, the incidence has seemed to increase. Most of these patients die before reaching the hospital from severe associated injuries. Isolated bronchial injury is even more rare than tracheal injury, and it is the focus of the present study. A retrospective national survey was conducted among all tertiary referral and trauma centers in Israel regarding the period between the years 1983 and 1998. Only six cases (3 males and 3 females) of isolated bronchial rupture were found the throughout the country. Ages of the patients ranged from 2 to 14 years; all were involved in motor vehicle accidents, four of them as pedestrians. Ruptures occurred in the bronchus intermedicus (2 cases), left and right main bronchus (2 cases each). All but one patient went through primary repair. We give a full description of the procedure and discuss the literature regarding incidence, diagnosis, treatment, and outcome.

Injuries to the major airway after blunt thoracic trauma in children: review of 2 cases

“…Moreover, during the operation, air leak can be so large that often the surgeon must manually occlude it to enable an adequate ventilation of the patient (as with case patient 2). An efficient way to overcome this problem is to place a Fogarty catheter in the proximal end of the ruptured bronchus (to the best of our knowledge, this has not been described before), making even the performance of the bronchial anastomosis easier, because the main cause of late morbidity is stenosis of the airway at the anastomotic site [6].…”

“…Early treatment minimizes the risk for infection and need for pulmonary resection. Optimal timing for surgery seems to be during the first 48 hours [3,6], when finding the ruptured segment is easy but becomes difficult in chronic cases. Moreover, during the operation, air leak can be so large that often the surgeon must manually occlude it to enable an adequate ventilation of the patient (as with case patient 2).…”

“…Early bronchoscopy is the most useful and accurate method to confirm tracheobronchial rupture [3,5,6]. Early treatment minimizes the risk for infection and need for pulmonary resection.…”

Use of pre and intra-operative bronchoscopy in management of bronchial injury following blunt chest trauma

“…[12] Airway control bypassing the tear or selective intubation of the uninjured side helps in better intraoperative view and patient management. The literature shows that in the acute setting, majority of the cases can be tackled by suture closing[89] the tear but a few may require lobectomy or pneumonectomy. Lobectomy is usually resorted to when the lobar bronchi are damaged beyond repair.…”

“…Early surgical repair prevents infection and bronchial stenosis and decreases the need for lung resection. [8] In chronic bronchial rupture, fibrosis following atelectasis might prevent reexpansion and may even require pneumonectomy,[9] though, successful primary or delayed repair of bronchus have also been reported. [1011]…”