Successful use of self-expandable metal stents in iatrogenic
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As an alternative treatment to immediate surgical repair, endotracheal stent placement has been recently proposed in cases of iatrogenic tracheal damages.

Published in the journal Radiology Case Reports, the authors report a case of a 91-year-old male who developed sudden subcutaneous emphysema during a total laryngectomy for laryngeal carcinoma.

A tracheal tear at the distal third of the posterior tracheal wall was endoscopically assessed about 2 cm above the carina; CT confirmed the breach approximately 4 cm in length with associated pneumomediastinum and bilateral pneumothorax.

Two covered self-expandable metal stents were then coaxially released under fluoroscopic control to cover the defect, restoring the tracheal integrity and leading to a normal thoracic appearance at CT and X-ray after 72 hours.

Key learnings:-
- Surgery is considered to be the treatment of choice for post-traumatic or iatrogenic tracheal lesions.

- Accumulating evidence recently challenges this conventional approach, with more surgeons choosing to manage this issue conservatively. Selection criteria for conservative management are a matter of debate: some authors stress the fact that there should be no evidence of respiratory or haemodynamic instability, while others consider the length or depth of the laceration as the most important discriminants.

-As of yet, the criteria for guiding which patients will benefit from nonsurgical treatment remain poorly defined, and there is a growing need for clear guidance.

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Dr. v●●●d c●●●●a General Surgery
Jan 2, 2019Like