Iatrogenic Post-Intubation Tracheal Rupture: The Role of Angio-CT in Diagnosis and Management

Abstract

Iatrogenic tracheal rupture is a rare but potentially fatal complication of orotracheal intubation, with an estimated incidence ranging from 0.005% to 0.37% of procedures.1,2 It affects women over 50 years of age more often than other populations, and most tears involve the posterior membranous wall of the trachea. We report the case of a 55-year-old woman who developed acute respiratory distress with cervicothoracic subcutaneous emphysema and oxygen desaturation to 92% on the fourth postoperative day following spinal surgery performed under general anesthesia. Pulmonary embolism was clinically suspected. Chest angio-CT ruled out this diagnosis by demonstrating normal opacification of the pulmonary arteries, and identified a right posterolateral tracheal tear measuring 2.28 mm × 7 mm at the T3 level, associated with pneumomediastinum and bilateral pleural effusions. Given the limited size of the laceration and the patient's haemodynamic and respiratory stability, conservative management with oxygen therapy and antibiotic therapy led to full recovery, and the patient was discharged on postoperative day 14. This case, reported from a sub-Saharan African setting where published data remain scarce, underlines the decisive contribution of angio-CT to the differential diagnosis and therapeutic stratification of postoperative respiratory complications. This publication is available in full in Health Research in Africa.