# Complications and Treatment Challenges After Metallic Airway Stenting in a 10‐Year‐Old Child With a Malignant Mediastinal Tumour

## TL;DR

A 10-year-old child with a malignant tumor developed tracheal stenosis, requiring stent implantation, which later led to granulation tissue requiring careful removal strategies.

## Contribution

Presents a novel approach to managing refractory granulation tissue by removing stent retention sutures instead of full stent removal.

## Key findings

- Tracheal stent removal under extracorporeal membrane oxygenation prevented granulation recurrence for 2 years.
- Granulation in the bronchial stent was managed by removing the retention suture, avoiding full stent removal.
- The approach was safer and less invasive, with no granulation recurrence for over 10 months.

## Abstract

A 10‐year‐old patient underwent metallic stent implantation in the trachea and right main bronchus for tracheal stenosis caused by extramural compression from a posterior mediastinal malignant rhabdoid tumour. Following chemoradiotherapy, the tumour entered remission. One year and 6 months after stent placement, refractory granulation tissue formed in the tracheal stent. The stent was removed using a rigid bronchoscope under general anaesthesia with extracorporeal membrane oxygenation to prevent granulation recurrence. Thereafter, no recurrence of granulation occurred in the tracheal stent within 2 years; however, refractory granulation developed in the right main bronchial stent. Removal of the right main bronchial stent was considered. However, as sputum frequently adhered to the retention suture of the stent, the retention suture was removed using a flexible bronchoscope. Since then, there has been no granulation for more than 10 months.

We report a case of refractory granulation occurring 7 years after metallic stent implantation in the trachea and right main bronchus of a 10‐year old patient with tracheobronchial stenosis caused by a malignant posterior mediastinal tumour. The tracheal stent was ultimately removed with great effort due to refractory granulation tissue. However, subsequent granulation in the right main bronchial stent was managed by removing the stent's retention suture—a safer and less invasive approach that prevented recurrence.