Reza Bagheri1, Reza Afghani2, Seyed Ziaollah Haghi1, Seyed Hossein Fattahi Masoum3, Ali Sadrizadeh1. 1. Cardiothoracic Surgery & Transplant Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran CTSTRC@mums.ac.ir. 3. Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
BACKGROUND: Bronchial avulsion is a serious complication of blunt chest trauma, which can be easily missed on initial presentation of a patient with multiple injuries. Missing the diagnosis may increase the risk of mortality and morbidity. METHODS: We evaluated the outcome of 10 patients with bronchial injury following blunt chest trauma, who underwent bronchial anastomosis in Quaem Hospital, Mashhad, Iran and Imam Khomeini Hospital, Tehran, Iran, from 2001 to 2012. There were 8 men and 2 women with a mean age of 23.1 ± 4.72 years. Associated injuries were ruled out in all cases. Demographic characteristics, anatomical location of the injury, mechanism of injury, complications of bronchial anastomosis, and one-year follow-up of the patients were studied. RESULTS: Eight patients had injury to the right main bronchus and 2 had injury to the left main bronchus. The time between surgery and diagnosis ranged from immediately to 6 months after injury. One death occurred in the operating room immediately after injury, due to asphyxia. The other 9 patients underwent successful anastomosis of the avulsed bronchus. There were 7 complications after repair, which were managed by a conservative approach. In one year of follow-up, one patient with residual stenosis underwent stent placement. CONCLUSION: Early diagnosis of major airway injury is an important factor in successful management and a favorable outcome. With improvements in surgical technique, regular follow-up, and effective management of complications, we can expect successful bronchial repair to save the lung, even with a late diagnosis.
BACKGROUND: Bronchial avulsion is a serious complication of blunt chest trauma, which can be easily missed on initial presentation of a patient with multiple injuries. Missing the diagnosis may increase the risk of mortality and morbidity. METHODS: We evaluated the outcome of 10 patients with bronchial injury following blunt chest trauma, who underwent bronchial anastomosis in Quaem Hospital, Mashhad, Iran and Imam Khomeini Hospital, Tehran, Iran, from 2001 to 2012. There were 8 men and 2 women with a mean age of 23.1 ± 4.72 years. Associated injuries were ruled out in all cases. Demographic characteristics, anatomical location of the injury, mechanism of injury, complications of bronchial anastomosis, and one-year follow-up of the patients were studied. RESULTS: Eight patients had injury to the right main bronchus and 2 had injury to the left main bronchus. The time between surgery and diagnosis ranged from immediately to 6 months after injury. One death occurred in the operating room immediately after injury, due to asphyxia. The other 9 patients underwent successful anastomosis of the avulsed bronchus. There were 7 complications after repair, which were managed by a conservative approach. In one year of follow-up, one patient with residual stenosis underwent stent placement. CONCLUSION: Early diagnosis of major airway injury is an important factor in successful management and a favorable outcome. With improvements in surgical technique, regular follow-up, and effective management of complications, we can expect successful bronchial repair to save the lung, even with a late diagnosis.
Authors: Lori M van Roozendaal; Matthijs H van Gool; Roy T M Sprooten; Bart A E Maesen; Martijn Poeze; Karel W E Hulsewé; Yvonne L J Vissers; Erik R de Loos Journal: J Thorac Dis Date: 2018-09 Impact factor: 2.895