INTRATRACHEAL GRANULOMA-FORMATION - A LATE COMPLICATION OF MARLEX MESH SPLINTING FOR TRACHEOMALACIA

External splinting of the trachea has been used alone or in combinatio n with aortopexy for the treatment of severe tracheomalacia. The autho rs describe the case of a 12-year-old boy who had a Marlex mesh splint placed because of life-threatening primary tracheomalacia at 6 months of age. He presented at 12 years of age with a 5-month history of sho rtness of breath on exertion, dry cough, and audible wheeze. Radiologi cal and endoscopic examinations showed near-complete obstruction of th e orifice of the right main-stem bronchus by a large polypoid granulom a. Initially the patient was treated with endoscopic resection on two occasions, but the granuloma and bronchial obstruction recurred each t ime. He underwent a right thoracotomy, which showed that the lower edg e of the mesh had eroded through the trachea wall and was acting as a nidus for granuloma formation. After removal of the mesh, the resultin g defect at the site of erosion of the trachea was closed with a peric ardial patch. The postoperative course was uncomplicated, and the pati ent remains well 2 years after surgery. External sprinting of the trac hea has been shown to be effective in the treatment of complicated tra cheomalacia, but one must be aware of the potential long-term complica tions, as demonstrated in this case. Copyright (C) 1996 by W.B. Saunde rs Company