Iatrogenic tracheobronchial rupture after emergency intubation

Main Article Content

Holger Rupprecht Harald Dormann Katharina Gaab


Tracheal rupture is a rare but serious complication after endotracheal intubation.

We report the case of an 85-years-old female patient presenting a massive skin emphysema after endotracheal emergency intubation. A CT-scan of the thorax showed a massive mediastinal emphysema and a dislocated tube cuff in the pleural cavity. The implemented bronchoscopy also showed the suspicion for tracheal rupture.

A double-lumen-tube-intubation failed due to a trapped tube cuff, which could not be extracted.  In the following emergency surgery, the transthoracic intubation of the left main bronchus was the lifesaving procedure. Afterwards a successful tracheal reconstruction was made. 

When tracheal rupture occurs early detection and an accurate treatment is necessary.

Keywords: Emergency intubation, cardiopulmonary resuscitation, tracheobronchial rupture, transthoracic bronchial intubation

Article Details

How to Cite
RUPPRECHT, Holger; DORMANN, Harald; GAAB, Katharina. Iatrogenic tracheobronchial rupture after emergency intubation. Medical Research Archives, [S.l.], v. 8, n. 7, july 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2186>. Date accessed: 16 june 2024. doi: https://doi.org/10.18103/mra.v8i7.2186.
Research Articles


1. Zlotnik A, Gruenbaum SE, Gruenbaum BF, Dubilet M, Cherniavsky E. Iatrogenic tracheobronchial rupture: A case report and review of the literature. International Journal of Case Reports and Images. 2011;2(3):12-16.
2. Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997;12(1):98-100.
3. Spaggiari L, Rusca M, Carbognani P, Solli P. Tracheobronchial laceration after double-lumen intubation for thoracic procedures. Ann Thorac Surg. 1998;65(6):1837-1839.
4. Lim H, Kim JH, Kim D, Lee J, Son JS, Kim DC, Ko S. Tracheal rupture after endotracheal intubation—a report of three cases. Korean J Anesthesiol. 2012;62(3):277–280.
5. Xu X, Xing N, Chang Y, et al. Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review. Int Wound J. 2016;13(2):268-271.
6. Paraschiv M. Iatrogenic tracheobronchial rupture. J Med Life. 2014;7(3): 343–348.
7. Conti M, Pougeoise M, Wurtz A, et al. Management of postintubation tracheobronchial ruptures. Chest. 2006;130(2):412-418.
8. Marty-Ané CH, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg. 1995;60(5):1367-1371.
9. Miñambres E, Burón J, Ballesteros MA, Llorca J, Muñoz P, González-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg. 2009;35(6):1056-62
10. Deja M, Menk M, Heidenhain C, et al. Strategies for diagnosis and treatment of iatrogenic tracheal ruptures. Minerva Anestesiol. 2011;77(12):1155-1166.
11. Kaloud H, Smolle-Juettner FM, Prause G, List WF. Iatrogenic ruptures of the tracheobronchial tree. Chest. 1997;112(3):774-778.
12. Rupprecht H, Rümenapf G, Petermann H, Günther K. Transthoracic bronchial intubation in a case of main bronchus disruption. J Trauma 1996;41(5):895-897.
13. Chen EH, Logman ZM, Glass PS, Bilfinger TV. A case of tracheal injury after emergent endotracheal intubation: a review of the literature and causalities. Anesth Analg. 2001;93(5):1270-1271.
14. Wagner A, Roeggla M, Hirschl MM, Roeggla G, Schreiber W, Stert F. Tracheal rupture after emergency intubation during cardiopulmonary resuscitation. Resuscitation. 1995;30(3):263-266.
15. Lampl I. Taracheobronchial injuries: Conservative treatment. Interact Cardio Vasc Thorac Surg. 2004;3(2):401-405
16. Schultz SC, Hammon JW, Turner CS, McGuirt WF, Nelson JM. Surgical management and follow-up of a complex tracheobronchial injury. Ann Thorac Surg. 1999;67:834-836
17. Elicora A, Akgül AG, Topcu S, Özbay S, Hosten T, Sezer HF, Elicora SS. Management of post-intubation tracheal membrane ruptures. Arch Iran Med. 2016;19(7):491-495.
18. Medina CR, Camargo J, Felicitti JC, Machuca TN, de Moraes Gomes B, Melo IA. Post-intubation tracheal injury: report of three cases and literature review. J Bras Pneumol. 2009;35(8):809-813
19. Hofmann HS, Rettig G, Radke J, Neef H, Silber RE. Iatrogenic ruptures of the tracheobronchial tree. Eur J Cardiothorac Surg. 2002;21(4):649-652.
20. Massard G, Rouge C, Dabbagh A et al. Tracheobronchial lacerations after intubation and tracheotomy. Ann Thorac Surg. 1996;61(5):1483-1487.
21. Gabor S, Renner H, Pinter H, Sankin O, Maier A, Tomaselli F, Smolle FM. Indications for surgery in tracheobronchial ruptures. Eur J Cardiothorac Surg. 2001;20(2):399-404.
22. Wallet F, Schoeffler M, Duperret S, Robert MO, Workineh S, Viale JP. Management of low tracheal rupture in patients requiring mechanical ventilation for acute respiratory distress syndrome. Anaesthesiology 2008; 108(1):59-62
23. Rupprecht H, Gaab K. Tension pneumopericardium in a multiply injured child. Asian Cardiovasc Thorac Ann. 2017 Sep-Oct;25(7-8):550-552