Eur Surg (2010) 42/5: 237–240 european surgery ACA Acta Chirurgica Austriaca Printed in Austria DOI 10.1007/s10353-010-0560-z © Springer-Verlag 2010 Extensive tracheal injury in penetrating neck trauma – a case report and management discussion S. Dalal, R. K. Karwasra, S. Parshad Department of General Surgery, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences (P.G.I.M.S.), Rohtak, Haryana, India Received April 19, 2010; accepted after revision August 31, 2010 Trachealverletzung bei traumatischer Halsperforation – Fallbericht und Managementdiskussion Zusammenfassung. Grundlagen: Perforationsverletzun- gen am Hals ko ¨nnen große Gefa ¨ße, die Trachea mit Intubationsproblemen, den O ¨ sophagus oder das Ru ¨ cken- mark betreffen. Methodik (Fallbericht): Penetrationstrauma am Hals im Rahmen eines Verkehrsunfalles mit ausgepra ¨gter Tracheal-Lazeration mit rechtsseitigem Pneumothorax und respiratorischem Versagen. Die Bronchoskopie zeig- te Trachealverletzungen an 2 Stellen. Der Patient wurde mit Doppellumen-Intubation beatmet, die Trachealver- letzungen via rechter Thorakotomie und mittlerer Hals- inzision versorgt. Ergebnisse: Unauffa ¨lliger postoperativer Verlauf. Schlussfolgerungen: Isolierte Trachealverletzungen sind selten nach Penetrationstrauma, die Intubation und das Management richten sich nach dem bronchosko- pischem Befund. Schlu ¨sselwo ¨rter: Intubation, Penetrationstrauma, Tra- chealverletzung, Thorakotomie. Summary. Background: Any penetrating trauma to the neck may cause damage to great vessels resulting in massive bleeding or injury to the trachea, esophagus or spinal cord. Such injuries sometimes pose a real intuba- tion challenge. Methods (Case report): We report a case of penetrat- ing neck injury with isolated but extensive tracheal lacer- ation. The sharp curved hook of a heavy automobile entered through suprasternal area of neck of a bike rider in a road accident. The patient presented with right-sided pneumothorax and respiratory collapse. Bronchoscopy revealed injuries at two sites in the trachea. The patient was intubated with unique method of double tube intu- bation. Injuries of trachea were repaired by right thora- cotomy and midline cervicotomy. Results: The patient made an uneventful recovery by this unique method of intubation and tracheal repair. Conclusions: Isolated tracheal injuries are very rare in penetrating road accident wounds and the intubation and operative strategy may change according to bron- choscopic findings. Keywords: Endotracheal intubation, penetrating trau- ma, tracheal injury. Introduction Penetrating injuries of the cervical trachea are infrequent in road accidents. They are life-threatening either be- cause of the immediate danger to the airway or due to associated vascular, esophageal or spinal cord injuries [1]. These injuries pose a distinct management problem be- cause of rapid onset of symptoms in such cases. Success- ful repair of penetrating tracheal injury at two sites in a young male is reported. Other significant diagnostic and treatment strategies reported in the literature are also discussed. Case report A 28-year old, male patient with severe dyspnea after sustaining a penetrating injury in suprasternal area of neck (zone I) in a road accident was brought to emer- gency department of our hospital. On examination, he was having tachycardia, hypotension, subcutaneous em- physema in neck and no breath sounds over right hemi- thorax. Immediate right tube thoracostomy was done, but the right lung did not expand and a massive air leak was present through the intercostal tube. The patient was not maintaining oxygen saturation and was developing respi- ratory failure. Looking at the critical condition of the patient, contrast enhanced computed tomography thorax Correspondence: Satish Dalal, M.D., Pt. B. D. Sharma Postgraduate Institute of Medical Sciences (P.G.I.M.S.), 9J/54, Medical Campus, Rohtak-124001, Haryana, India. E-mail: drsatishdalal@gmail.com Extensive tracheal injury in penetrating neck trauma © Springer-Verlag 5/2010 Eur Surg 237 Case Report