Iatrogenic Tracheal Injury During Hemithyroidectomy: A Case Report
Iatrogenic Tracheal Injury
Abstract
Iatrogenic tracheal injury (ITI) can occur in operations, intubation or tracheobronchial endoscopy. ITI associated with hemithyroidectomy is a very rare but devastating complication which can manifest immediately or in a delayed manner. The therapeutic approach can be conservative or surgical, but there is no universal consensus on the management. In this article, we described a rare case of intra-operative tracheal injury involving the cricothyroid membrane and right posterolateral first to second tracheal rings during right hemithyroidectomy, in which primary suturing was attempted. However, on the sixth day postoperatively, the patient developed neck swelling and respiratory distress owing to infection at surgical site complicated with temporary vocal cord palsy, which necessitated a tracheostomy. Patient was subsequently managed successfully with conservative management. We concluded that the therapeutic approach of ITI should be based on the time of presentation, clinical condition of the patient, size and location of the lesion.
Keywords :
Hemithryoridectomy; iatrogenic,
tracheal injury,
Abstrak
Kecederaan trakea iatrogenik (ITI) boleh berlaku semasa pembedahan, intubasi atau endoskopi trakeobronkial. ITI yang dikaitkan dengan hemitiroidektomi ialah komplikasi yang jarang berlaku tetapi boleh mendatangkan kesan yang serius. Gejala ITI boleh muncul secara serta-merta atau lewat. Rawatan ITI meliputi cara konservatif atau pembedahan, namun tiada garis panduan piawai mengenai kaedah pengurusannya. Dalam artikel ini, kami melaporkan satu kes melibatkan kecederaan trakea yang berlaku semasa pembedahan hemitiroidektomi, melibatkan membran krikotiroid dan cincin trakea posterolateral kanan pertama hingga kedua semasa hemitiroidektomi kanan, di mana jahitan primer telah dilakukan. Walau bagaimanapun, pada hari keenam selepas pembedahan, pesakit mengalami pembengkakan leher dan kesukaran bernafas akibat jangkitan pada tapak pembedahan yang disertai dengan kelumpuhan sementara pita suara, sehingga memerlukan prosedur trakeostomi. Pesakit kemudiannya berjaya dirawat dengan pendekatan konservatif. Kesimpulannya, pendekatan terapeutik terhadap ITI perlu disesuaikan berdasarkan kepada masa pesakit hadir, keadaan klinikal pesakit, serta saiz dan lokasi kecederaan.
Correspondance Address
Chan Zhi San. Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. 56000 Kuala Lumpur, Malaysia. Tel: +603 91456046 E-mail: c.zhisan@gmail.com
