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Year 2014 Vol. 22 No 4
S.A. DOGJANI 1, E.B. HASANAJ 1, E. MATEVOSSIAN2, D. DOLL 3
MANAGEMENT OF THE BLUNT PEDIATRIC CERVICAL TRAUMA – CHALLENGE FOR THE TRAUMA SURGEON AND THE OPTIONS OF SOLVING THEIR EMERGENCY CONDITIONS
University Hospital of Trauma,
National Trauma Center1, Tirana, Albania,
Hospital “Rechts der Isar“2, Munich, Germany
St. Mary's Hospital 3, Vechta, Germany
Blunt injuries to the chest are not rare but if present are usually associated with either a direct impact to chest and neck or acceleration-deceleration injuries. Such injuries are associated with concomitant injuries to the cervical structures. This particular type of injury thus presents a diagnostic and therapeutic challenge to emergency physicians, anesthetists and surgeons alike. We report a case of tracheal injury due to blunt upper thoracic trauma which surgeons have successfully coped.
A 12-year-old boy fell from bicycle and sustained blunt injury to his upper chest aperture. He was brought to the hospital (6 h later) with pain in the chest, difficulty in breathing and inability to speak. His heart rate (HF) was 120/min, systolic blood pressure (SBP) was 110/70 mm Hg, respiratory rate (RR) was 32/min and SaO2 was 90%. This case is interesting in subcutaneous emphysema extending from his upper chest to his head, covering neck and throat. Radiographs and CT scan revealed a right-sided pneumothorax, pneumomediastinum and tracheal deviation. The patient was emergently taken to the operating room and a right-chest tube was placed. The patient underwent fiber optic examination of the trachea, where a injury 2-3 cm below of longitudinal direction (1 cm) in the anterior membranous part of the trachea has been detected, thus formally the trachea was ruptured. During the procedure the child's condition deteriorated with diminishing SaO2 down to 86% and difficulty in breathing but the child was hemodynamically stable. Under these conditions emergency intervention tracheotomy has been performed. Immediately all respiratory parameters returned to normal. The next morning the symptoms and signs were normal with no further complications. The patient was discharged home after a few days. Tracheal injury is a rare complication of blunt chest trauma. The patients usually present with symptoms and signs of respiratory distress. Primary repair is the treatment of choice in case of large defects, while small tears can be managed conservatively. Immediate operation is recommended to improve deteriorating pulmonary function.
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Department of Surgery, St. Mary's Hospital Vechta, Marienstr. 6-8, D-49377 Vechta, Germany. Europe
PD Dr. Dietrich Doll, MD, PhD
Dogjani S.A. MD, PhD, General Surgeon at the University Hospital of Trauma, National Trauma Centre, Tirana, Albania
Hasanaj E.B. MD, General Surgeon at the University Hospital of Trauma, National Trauma Centre, Tirana, Albania
Matevossian E. MD, PhD, Hospital “Rechts der Isar”, Munich, Germany
Dietrich Doll, MD, PhD. Priv-Doz. Dr. Department os Surgery, St. Mary's Hospital 3, Vechta, Germany