Tracheal Laceration with Massive Subcutaneous Emphysema: A Rare Complication of Endotracheal Intubation

Although uncommon, and rarely reported, esophageal perforation has significant medical and legal consequences. Upper aero digestive tract injury can result in severe complications like pneumothorax, pneumonia, retropharyngeal abscess, retrosternal abscess, mediastinitis etc. Such patients have very poor outcome especially if there is a delay in diagnosis and treatment. Our patient sustained a laceration of the upper esophagus associated with subcutaneous emphysema after a difficult direct laryngoscopy and failed intubation. The importance of prompt diagnosis and treatment in the event of this rare complication and the different causative factors are discussed. KEYWORDS: Esophageal laceration, endotracheal Intubation, subcutaneous emphysema. INTRODUCTION: Aero-digestive tract injury during general anesthesia is a significant source of morbidity for patients and a source of liability for anesthesiologists. Karen B. Domino et al 1 analysed the ASA Closed Claims database which showed that most claims for esophageal injuries were for esophageal perforation (n= 43 of 48 esophageal injuries, 90%). Sixty-two percent (n= 30) of all esophageal injuries were associated with difficult intubation (P <0.001 compared with all other sites combined.). In addition, esophageal injuries involved a significantly greater proportion of females (P <0.001) and patients older than 60 yr of age (P<0.001) compared with other sites combined. Esophageal injuries were more severe than all other types of airway injury combined, with 9 (19%)