Tips and tricks in tracheobronchial perforations

Background: This study aims to present our experience regarding tracheobronchial perforations and their management. Methods: Records of 16 patients (9 males, 7 females; mean age 46.6 years; range 1 to 83 years) with tracheobronchial perforation between January 1999 and March 2015 were retrospectively evaluated according to age, sex, symptoms, radiological findings, diagnostic methods, therapeutic options, localization of perforation, length of perforated area, intubation difficulty, etiological causes, clinical course, and complications of treatment. Results: The most frequent radiological finding was subcutaneous emphysema (n=6). Mean length of perforations was 2.6 cm (range 0.5 to 8 cm). The localizations of perforations were trachea in 12 patients (75%), left main bronchus in three patients (18.8%), and trachea plus right main bronchus in one patient (6.2%). Diagnosis was confirmed by bronchoscopy in 11 patients (68.7%) and inspection findings were sufficient in the remaining five patients (31.3%). Causes of tracheobronchial perforations were iatrogenic in 12 patients (75%), self-expandable esophageal metallic stent in two patients (12.5%), gunshot wound, and stab wound in one patient each (6.25%). Surgery was performed in 12 patients and observation was sufficient in two patients. We offered tracheal stent to patients with esophageal stent; however, one of them refused our offer and he died at home, while the other patient died in the hospital while waiting for the purchase of the tracheal stent. In postoperative period, esophageal fistula developed in one patient while total atelectasis developed in left lung of another patient. Four patients died but none of them was related to our surgical procedures. Conclusion: The basic management in airway perforations is early diagnosis and surgical treatment. Surgery may be performed with low complication rate.