Turkish Archives of Otorhinolaryngology
Case Report

Tracheo-innominate Artery Fistula in a Complicated Penetrating Neck Trauma: A Successfully Managed Rare Complication of Low Tracheotomy

1.

Department of Otorhinolaryngology, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India

2.

Department of Cardio Thoracic Vascular Surgery, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India

Turk Arch Otorhinolaryngol 2020; 58: 127-129
DOI: 10.5152/tao.2020.5006
Read: 104 Downloads: 44 Published: 10 July 2020

Tracheo-innominate artery fistula is a rare complication of tracheotomy with very high mortality rate. Only a few patients survive this complication as reported in the literature. Here we report the case of a 54-year-old gentleman who presented to the emergency department with a history of penetrating neck trauma following a road traffic accident. Neck exploration and tracheotomy were done to secure the airway. After two weeks, the patient had an episode of massive stomal bleed for which he was taken to the operating room and re-explored. A tracheo-innominate artery fistula was detected, and right side aorto-carotid and right side aorto-subclavian anastomoses were done using reversed saphenous vein graft with interruption of flow. Following a successful surgery, the patient was decannulated later, and now lives a healthy normal life. Early diagnosis and immediate intervention are the key in managing this complication. Bedside management also plays a vital role.

 


 

Trakeoinnominat arter fistülü, trakeotominin ender görülen ve mortalitesi yüksek bir komplikasyonudur. Literatürde bu komplikasyondan sağ kurtulan ancak birkaç hasta bildirilmektedir. Çalışmamızda, trafik kazası sonrasında penetran boyun travması öyküsüyle acil servise başvuran 54 yaşındaki bir erkek hasta sunuldu. Havayolu sağlamak amacıyla hastaya boyun eksplorasyonu ve trakeotomi uygulandı. Hasta, semptomatik iyileşme gösterdi. İki hafta sonra şiddetli bir stomal kanama atağı yaşayan hasta ameliyathaneye alınarak yeniden eksplore edildi. Trakeoinnominat arter fistülü saptanması üzerine, akış durdurularak ters safen ven grefti ile sağ aorta-karotid ve sağ aorto-subklaviyen arter anastomozu yapıldı. Cerrahinin başarıyla sonuçlanması üzerine daha sonra kanül çıkarıldı. Hasta şu anda iyi durumda olup, sağlıklı normal bir yaşam sürmektedir. Erken tanı ve hızlı müdahale bu komplikasyonun tedavisinde önemlidir; yatakbaşı yönetimi yaşamsal rol oynamaktadır.

 

Cite this article as: Karunakaran V, Nair NP, Alexander A, Munuswamy H, Rajan N, Ganesan S. Tracheo-innominate Artery Fistula in a Complicated Penetrating Neck Trauma: A Successfully Managed Rare Complication of Low Tracheotomy. Turk Arch Otorhinolaryngol 2020; 58(2): 127-9.

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ISSN2667-7466 EISSN 2667-7474