Management of Tracheobrochial Injuries: A 10-Year Experience at Ratchaburi Hospital
Chanin Glinjongol, MD*, Bussaba Pakdirat, MD**
Affiliation : * Department of Surgery, Ratchaburi Hospital, Ratchaburi ** Department of Radiology, Ratchaburi Hospital, Ratchaburi
Background and Objective : Tracheobronchial injuries are rare but life threatening. Their successful diag-
nosis and treatment require a high level of suspicion and early surgical repair. The authors review their
experience in managing these injuries over the past 10 years.
Materials and Methods : Patients who were admitted to the Thoracic Surgical Unit, Ratchaburi Hospital and
treated for tracheobronchial injuries from 1993 to 2004 were included in the present study. Hospital records
were reviewed on mechanism of injury, clinical presentation, diagnosis, management and outcome.
Results : The present series comprised of 11 tracheobronchial injury patients. Causal mechanism of injury
was 4 blunt and 7 penetrating injuries.
4 of them with blunt injury, there were 3 right main bronchial disruptions, 1 minor cervical lacera-
tion. Presenting signs included dyspnea in 4 and subcutaneous emphysema in 3. 1 of them had massive air
leak. Radiographic finding were pneumomediastinum in 3. Pneumothorax in 2, Atelectasis of right lung in 1.
All of the right bronchial disruptions had primary repair with reanastomosis in 2 and resection of stenotic
bronchus with reanastomosis in 1; this patient developed empyema thoracis with Acinetobacter iwoffii as a
result of delayed diagnosis (40day). One patient with minor cervical laceration underwent conservative
treatment. All patients with blunt injuries were discharged with a normal patency of airway.
7 patients with penerating injuries, there were 4 cervical, 1 cervical associated with esophageal
injury, 1 combined cervical-thoracic type of injuries and 1 Thoracic injury. Presenting signs included dyspnea
in 7 and subcutaneous emphysema in 6. The radiographic finding were pneumomediastinum in 5 pneu-
mothorax in 4, one patient underwent tracheal reanastomosis. The rest of six patients underwent immediate
primary repairs. One patient with cervical knife stap wound died 4 hours postoperatively of hemoptysis,
progressive hypoxia and aneuria, 6 of them were recovered with a normal patency of airway
Conclusion : The authors concluded that, result of treatment for tracheobronchial injury should depend
upon the mechanism of injury, early recognition, early diagnosis and appropriate surgical intervention.
Delay in diagnosis is the single most important factor-influencing outcome. Common complications in the
early phase were hypoxia, organ failure while in the late phase were sepsis, tracheal or bronchial stenosis,
mediastinitis and chronic bronchopleural fistula, etc.
Keywords : Tracheobronchial injuries, Major bronchial injury, Bronchial disruption, Tracheal injury
