Right Tracheobronchial Injury Due to Endotracheal Tube Malpositioning: A Case Presentation

Abstract

Our case was a 49-year old female patient operated for hepatic hydatid disease under general anesthesia. The operation was stopped due to development of desaturation (SpO2<80%) at the 30th minute and detection of subcutaneous emphysema of neck and chest. The administration of anesthetic gases was interrupted and 100% oxygen ventilation was initiated. Auscultation revealed reduction of the breath sounds in the left lung. The lung graphy and fiberoptic bronchoscopy (FOB) of the patient revealed left lung atelectasis and diffuse subcutaneous mediastinal emphysema. No tracheobronchial injury or tracheoesophageal rupture was considered in the first FOB evaluation. The patient was inserted a left thoracic tube and operation was proceeded by fixation of this tube. After the operation that lasted for 70 minutes without a complication, a lung graphy was performed while the patient was intubated and thoracic tomography and transferred to the intensive care unit. The patient was initiated monitorization and supportive treatment on synchronized intermittent mandatory ventilation (SIMV-PC) mode under sedoanalgesia. The second FOB evaluation revealed air bubble and a right thoracic tube was connected to the patient. No additional surgery was planned. The lung graphy performed in the 5th admission day showed expansion of the right lung and the right thoracic tube was withdrawn. Weaning was attempted in the 5th admission day. The patient was extubated and connected to O2 mask (4 lt/min). The patient with stable vital findings and normal levels of blood gases was transferred to the relevant clinic.

Keywords

• Intubation
• subcutaneous emphysema
• anesthesia