SURGERY FOR TRAUMATIC BRONCHIAL RUPTURE

We have operated on four patients with traumatic bronchial rupture. The location of the traumatic rupture was the main bronchus in all four cases. Diagnostic clues were bloody sputum, dyspnea, mediastinal emphysema on chest XP and subcutaneous emphysema in the neck. Accurate diagnosis was made by either bronchoscopy or urgent thoracotomy. Delay in diagnosis was experienced in one patient in whom fibrous tissues at the separated edge of the ruptured bronchus had developed well enough to maintain the airway, but subsequently followed by bronchial stenosis. It is obvious that delay in diagnosis results in parenchymal damage to the lung such as atelectasis, fibrosis or inflammation, and the longer the delay in therapy, the greater the damage to the lung. Our patients included a 5-year-old boy in whom both the main and the middle bronchi on the right were ruptured. This experience showed that even a 5-year-old boy could become a candidate for bronchoplastic surgery, if he is given special care including an indwelling catheter to remove the bronchial secretion during the first or second postoperative day.