Successful treatment of complicated tracheobronchial rupture using primary surgical repair.

Traumatic tracheobronchial disruption is a life threatening injury in the pediatric population. The clinical presentations are variable depending on whether the peribronchial tissues remain intact. A high index of clinical suggestion and accurate interpretation of radiological findings are necessary to diagnose the injury. Delays in treatment increase the risk of death and complications. We report a 9-year-old boy who presented with subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, and respiratory failure. Bronchoscopy revealed a complex rupture of the airway over the junction of the right main upper lobar and intermediate bronchus. Emergent surgical intervention was performed via a right posterolateral thoracotomy after bilateral chest tube insertion. End-to-end anastomosis of the disrupted bronchus was completed with interrupted absorbable 4-0 vicryl without additional covering of the anastomosis with pleural or muscle flap and intra-operative bronchoscopy showed a normal anastomotic relationship after the procedure was completed. The patient was discharged in good condition 10 days after the operation. At 6 months of follow up, he had good health status and bronchoscopy showed good patency over the anastomotic region.