Estenosis Traqueal

Wong et al. Cases Journal 2010, 3:2
http://www.casesjournal.com/content/3/1/2

CASE REPORT

Open Access

Successful treatment of tracheal stenosis by rigid
bronchoscopy and topical mitomycin C: a case
report
Jyi Lin Wong1*, Siew Teck Tie1, Bohari Samril2, Chee Lun Lum2, Mohammad Rizal Abdul Rahman3,
Jamalul Azizi Abdul Rahman1

Abstract
Tracheal stenosis is a known complication ofprolonged intubation. It is difficult to treat and traditional surgical
approach is associated with significant risk and complications. Recurrent stenosis due to granulation tissue necessitates repeated procedures. We describe a case of short web-like tracheal stenosis (concentric membranous stenosis
less than 1 cm in length without associated cartilage damage) managed by a minimally invasivethoracic endoscopic approach. Topical application of Mitomycin C, a potent fibroblast inhibitor reduces granulation tissue formation and prevents recurrence.
Introduction
MacEwen first reported endotracheal intubation for
anesthesia in 1880 [1]. Lindholm reported injuries to the
larynx and trachea after intubation in 1969 [2]. Despite
advancement and the use of high volume, low pressurecuffed tubes, tracheal stenosis is not an uncommon
complication of endotracheal intubation. In one prospective study of critically ill patients, 11% of patients
who were intubated with high volume, low pressure
cuffed tubes developed tracheal stenosis [3]. Endotracheal tube causes pressure injury to the glottis and may
result in severe commissural scarring that is difficult to
treat.
Althoughthere have been reports of successful treatment of tracheal stenosis with steroid regimens [4,5],
the mainstay of treatment for symptomatic lesions is
surgical. Various surgical methods have been described
including anterior cricotracheal splitting, laryngofissure
creation with anterior lumen augmentation, resection or
end-to-end anastomosis [6-8], but they are not without
risks. Trachealreconstruction requires major surgery,
with a mortality of about 3% [9,10]. Rigid bronchoscopy
with tracheal dilatation and stenting has been described
as some of the treatment methods for less serious
* Correspondence: sgrejang@yahoo.com
1
Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota
Kinabalu, Sabah, Malaysia

lesions [11]. Relapses are relatively frequent, making itthe principal long-term problem with this method of
treatment [12,13].

Case presentation
A 30-year-old Malaysian woman who had bilateral
upper lobe lung bullae underwent bullectomy in May
2008 for rapidly enlarging bullae causing respiratory
compromise. Post-operatively, she was intubated for 6
days. Upon trial of extubation at day 6, she developed
shortness of breath. She wasre-intubated for another 5
days before extubation was successful and she was discharged 20 days post operatively.
She was well for the next one month until July 2008
when she developed a sudden onset of shortness of
breath and stridor. Intubation attempt with a 4 mm
endotracheal tube was unsuccessful leading to emergency tracheostomy. Flexible bronchoscopy in the operating room revealed amembranous web-like concentric
stenosis without cartilage involvement 3 cm below the
vocal cords. Bronchoscopy through the tracheostomy
showed normal distal airways. A neck CT scan confirmed the presence of a short segment tracheal stenosis
(less than 1 cm) [figure 1].
In August 2008, she underwent rigid bronchoscopy
using a 12 mm Dumon rigid tracheal tube. This was followed by examination using asmall diagnostic flexible

© 2010 Wong et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.

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