Spiral Bronchial Rupture in a Young Trauma Patient: Critical Role of Bronchoscopy and Surgical Precision

TL;DR

A 16-year-old boy with a severe lung injury from a motorcycle accident was successfully treated using bronchoscopy and precise surgery.

Contribution

Highlights the critical role of bronchoscopy and surgical precision in managing rare, complex bronchial injuries.

Findings

Fiberoptic bronchoscopy was essential for diagnosis and stabilization of the patient.

A right pneumonectomy with reinforced bronchial stump closure led to a successful recovery.

Prompt airway management and surgical planning ensured a positive outcome in a life-threatening injury.

Abstract

Traumatic tracheobronchial injuries (TTBIs) are rare but potentially life-threatening complications of high-energy thoracic trauma, most commonly associated with road traffic accidents. These injuries demand prompt diagnosis and a multidisciplinary approach for effective management. We present the case of a 16-year-old male patient who sustained a spiral rupture of the right main bronchus following a motorcycle accident. Upon presentation to the emergency department (ED), the patient demonstrated severe hypoxemia and respiratory acidosis. Imaging confirmed the presence of a pneumothorax, necessitating the placement of bilateral chest tubes. Despite the intervention, a persistent air leak was observed. Fiberoptic bronchoscopy was used to confirm the diagnosis and stabilize the patient by isolating the unaffected left lung. Definitive surgical management via right thoracotomy revealed a complex spiral lesion in the right main bronchus, which was deemed irreparable. A right pneumonectomy was performed, and the bronchial stump was secured with 4-0 pledgeted sutures reinforced with fibrin glue. The patient’s postoperative course was uneventful, and he was discharged in good health 15 days later. Further follow-up demonstrated excellent health and no complications. This case highlights the critical role of fiberoptic bronchoscopy in the diagnosis and initial stabilization of TTBIs and emphasizes the importance of meticulous surgical techniques for managing complex bronchial injuries. The combination of prompt airway management and careful surgical planning ensured a successful outcome, even in the context of a severe, life-threatening, and technically challenging injury.

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