(A741) Video-Assisted Transcervical-Transtracheal Repair for Post-Intubation Tracheal Laceration: A Rare Case of Subcutaneous Emphysema

Introduction: Post-intubation tracheal laceration (PITL) is a rare but potentially life-threatening complication of endotracheal intubation. Clinical manifestations can range from subcutaneous emphysema and dyspnea to asymptomatic presentations. Early diagnosis and timely intervention are critical to reduce complications and mortality. This report highlights a case of significant subcutaneous emphysema caused by PITL, emphasizing clinical features, diagnostic approaches, and surgical management strategies.

Methods: A 30-year-old female with no prior medical history presented with extensive subcutaneous emphysema following elective orthopedic surgery. Physical examination and computed tomography (CT) revealed air accumulation extending from the trachea to the mediastinum. Endoscopic evaluation identified a 3 cm full-thickness laceration in the posterior tracheal wall, approximately 8 cm below the vocal cords. Surgical repair was performed via a video-assisted transcervical-transtracheal approach. Continuous monitoring of oxygen saturation necessitated intermittent apneic states during suturing of the laceration. The patient was temporarily managed with a tracheostomy.

Results: Postoperative recovery was uneventful, with gradual resolution of subcutaneous emphysema. The tracheostomy tube was successfully removed, and follow-up endoscopy after one month demonstrated complete healing of the posterior tracheal wall. This minimally invasive surgical approach facilitated excellent clinical outcomes with minimal complications.

Conclusions: This case highlights the importance of early recognition and intervention for PITL. Video-assisted transcervical-transtracheal repair offers a minimally invasive yet effective surgical option for posterior tracheal wall lacerations, especially in cases with exacerbated subcutaneous and mediastinal emphysema. While the technique may be time-consuming due to intermittent hypoxemia, its advantages in preserving tracheal integrity and promoting rapid recovery make it a valuable approach.