Management of tracheobronchial ruptures

We report the case of a 25-year-old man who suffered a severe trauma with a complete rupture and separation of the right main bronchus. The patient presented on the scene with respiratory distress and severe hypoxemia. At the admission in the trauma resuscitation unit, the CT scan and fiberoptic examination confirmed the diagnosis of right main bronchus rupture. Selective fiberoptic intubation of the left main bronchus was done and the patient was sent to the operating theater for urgent thoracotomy. During thoracotomy, profound arterial oxygen desaturation requested the right main bronchus being intubated by the surgeon under the control of view and separate lung ventilation, until the end of the bronchus suture. Surgery allowed the patient to survive. He was then discharged alive from the hospital at day 36. Severe tracheobronchial rupture may be rapidly associated with major respiratory distress and severe hypoxemia that necessitate specialised care in referring centre. Initial orientation of these patients appears to be as important that airway and hypoxemia management. (C) 2010 Elsevier Masson SAS. All rights reserved.