Ten patients were seen in Northern Syria with tracheobronchial injury from June 1986 to July 1988 Eight were male; and five were children.

Ten patients were seen in Northern Syria with tracheobronchial injury from June 1986 to July 1988 Eight were male; and five were children. obtuse trauma was the cause of feud in five and penetrating trauma in five. Nine patients had associated injuries. In seven the diagnosis was made within 24 h The seven patients who had surgery were well at last follow-up as was a child with a main bronchial tear who was treated conservatively. sum of two units men died without having surgery individual of respiratory failure and sepsis and the other of hemorrhagic brunt The group's mean age was 175 years. The average hospital stay was six days (eight for survivors), and the follow-up period was seven month The clinical presentations and issue stress the essential role of early chest x-ray and bronchoscopy as well as a high index of suspicion.

(Chest 1994; 106:74-78)

LMB=left main bronchus;

ML=middle lobe;

RMB=right main bronchus;

TBI=tracheobronchial injury

guide words: airway injury, chest trauma-wounds, tracheobronchial injury-rupture

Tracheobronchial injury (TBI) is a rare if it were not that potentially fatal complication of abrupt and penetrating chest trauma. Referral institutions in industrialized countries may receive undivided or two such cases a year.(1)(2)(3)(4)(5) This subject of attention documents ten cases of TBI in a setting where diagnostic and surgical facilities were limited.

MATERIALS AND METHODS

Ten patients with TBI were managed between June 1986 and July 1988 in four hospitals in Aleppo, Syria. None of these hospitals had facilities for family gas measurement, portable x-ray machines, or postoperative ventilation. Furthermore, there was no organized transport or trauma connected view Clinical data for the patients are listed in Tables 1 and 2

[TABULAR DATA OMITTED]

Rigid and flexible bronchoscopy instruments were taken to the hospitals by way of the surgeon. Thoracoscopy was performed with the rigid bronchoscope sterilized. Orobronchial intubation with a single-lumen endotracheal tube was accomplished on passing the tube into the noninjured bronchus through the whole extent of a small bougie (gumelastic 8-12 Fr) left in position at bronchoscopy A double-lumen endotracheal tube frequently was unavailable or too large for children. Integrity of bronchial closure was standarded by withdrawing the single-lumen tube into the trachea and applying positive influence ventilation. Interrupted polyglactin or polyglycolic acid line of junction was used in airway repairs and polypropylene line of junction in cardiovascular repairs.

CASE REPORTS

CASE 1

A lad of 11 years old was seen three weeks after he had been scud over by a cart and admitted to the hospital with respiratory distress, extensive surgical emphysema, and cough A chest x-ray film had shown a left tension pneumothorax (Fig 1) Total collapse and coming down of the left lung followed and persisted despite insertion of a series of thoracostomy tubes. clean radio-opacification of the left hemithorax, with mediastinal shift to the left later ensu in succession examination, the frail boy had brace infected drain sites. At the time of bronchoscopy the left main bronchus (LMB) tapered to a point 2 cm from the carina. Thoracotomy was undertaken when consensus was given two weeks later. close adhesions obliterated the aortopulmonary window and separated the blind closes of the avulsed LMB through 3 cm. Infected drain sites and difficult dissection necessitated pneumonectomy. The child was discharged 4 days after operation and 14 month later was seen thriving.

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CASE 2

A family car carrying 14 passengers crashed into a trade one evening. Of the nine survivors, a girl aged 10 years who had been conceit to be dead on arrival in the hospital had dyspnea, hemoptysis, and cyanosis. Tube thoracostomy had failed to expand her collapsed, "fallen" right lung Bronchoscopy confirmed total fracture of the right main bronchus (RMB) and separation of the expirations by 2.5 cm. At thoracotomy, the bronchus was sutur At discharge 9 days later and at a follow-up visit 18 month later, the right lung remained abundantly expanded.

CASE 3

A lad 4 years old was hit by way of a car and admitted to the hospital in bitter respiratory distress, with subcutaneous emphysema and cyanosis secondary to bilateral pneumothoraces (Fig 2) and fractures of the right eighth and ninth ribs. He had bilateral pleural drains inserted. Bronchoscopy 4 days later, for right upper lobe collapse and persistent air leak, showed a 15-cm tear of the RMB reaching the upper lobe orifice. Bronchoscopic removal of debris expanded the lobe. The air leak ceased at 9 days, the drain was remov and the child was discharged forward day 10. He was last seen 6 weeks later with a normal chest x-ray film.

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CASE 4

A youth aged 16 years was hit with a ball forward his right breast, collapsed, and his skin coloring became dusky. An hour later in the hospital, he was hypotensive and had a right tension pneumothorax. A chest tube drained air and 600 ml of life-blood Suction worsened the dyspnea and failed to reexpand the lung Bronchoscopy showed incomplete avulsion of the right upper lobe bronchus. unison for thoracotomy was initially withheld. Right thoracoscopy showed marked contusion of the lung an air leak from a hilar hematoma, avulsion of the internal thoracic utensils and subluxation of the third costal cartilage. At thoracotomy, a torn apical segmental vein was ligated, the distressingly contused right pulmonary artery reinforced with autologous pericardium, and the incompletely torn right upper lobe bronchus was repaired. He was discharged 8 days later, and was well with a normal chest x-ray film 13 month later.

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