Management of acute complete tracheal transection caused by nonpenetrating trauma: Report of a case and review of the literature

PERIOPERATIVE MANAGEMENT of an acute blunt traumatic tracheal injury is a rare event because, in part, of the significant high mortality in the prehospital course and the delay in diagnosis until days or even months after the initial trauma.(1) Physicians must therefore have a high clinical index of suspicion to provide expeditious diagnosis and timely interventions in airway management to minimize morbidity and mortality. An unusual case of a complete tracheal transection in which initial survival of the patient was sustained by an airway created by the peritracheal fascial tissues and intact pleura is presented. This patient survived despite a delay in definitive intervention until she was transferred to the authors' hospital, approximately 17 hours after the tracheal disruption. Perioperative management of this unique case is discussed with a brief review of recent literature including the incidence, mechanisms of injury, diagnosis, management strategies, and clinical course.