Primary repair of a completely ruptured intermediate bronchus after blunt chest trauma. Case report

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BACKGROUND: Tracheobronchial injury is rare and often has a fatal course. The incidence is estimated from 0.8% to 5% in the scenario of blunt or penetrating chest trauma. CASE PRESENTATION: A 54-year-old male was brought to the emergency department after falling off his bicycle, with impact on head and right shoulder. At pre-hospital assessment, the patient had a free airway, gasping respiration (oxygen saturation 92%) with reduced vesicular breathing. Multiple rib fractures are palpable bilaterally, with subcutaneous emphysema. Computed tomography (CT) showed a large right-sided pneumothorax and consolidated lung lobes. After insertion of two chest tubes on the right, a refractory pneumothorax with large air leakage remained present. Subsequently, a bronchoscopy was performed, confirming a complete rupture of the right intermediate bronchus. Urgent surgical debridement and primary repair with an end-to-end running suture was performed. Rib osteosynthesis was additionally performed bilaterally, because of a flail chest on the right side and penetrating bone fragment on the left side. Respiratory function recovered uneventfully. CONCLUSION: Airway injuries are uncommon but must always be suspected by the clinician during the early management of chest trauma. To prevent delayed diagnosis and potentially fatal outcome, low-threshold bronchoscopy is the diagnostic modality of choice to accurately confirm the lesion. Primary surgical repair remains the mainstay of the therapeutic management.

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