Tracheobronchial ruptures from blunt thoracic trauma in children

Background/Purpose: Tracheobronchial ruptures in blunt thoracic trauma in c hildren are rare. The aim of this study was to suggest the means of an earl y diagnosis and a conservative management as often as possible. Methods: Sixteen cases of tracheobronchial ruptures by blunt thoracic traum a were observed over 26 years in 9 regional pediatric centers. Results: There were 12 boys and 4 girls, from ages 1 hour to 17 years. Nine children presented with associated lesions. Fibroscopy established the fol lowing diagnosis: 8 tracheal wounds and 8 bronchial wounds. Six children we re operated on within 18 hours (on average) after installation of a thoraci c drainage. Two lobectomies, 3 ideal tracheal sutures, and 1 bronchial sutu re were performed. Seven children were treated exclusively by thoracic drai nage. Two of them were intubated through the lesion, leading to a transitor y endoprothesis accompanied or not by an external thoracic drainage. One in fant recovered spontaneously. There were no deaths in this series. Two recu rrent postoperative nerve injuries were noted, one of which was a transitor y spontaneously resolutive scar bud and one a granuloma treated by laser. T hree times, a stenosis occurred after a conservative management. Two were o perated on. Conclusions: Tracheobronchial ruptures in children are rare. An early fibro scopy holds an important place in the approach of this pathology. Treatment is variable, based on thoracic lesions, their tolerance by the child, and associated lesions. Surgery is not the only therapy because conservative tr eatment by simple thoracic drainage or lesion intubation has proved effecti ve. J Pediatr Surg 34:1847-1850. Copyright (C) 1999 by W.B. Saunders Compan y.