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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
Delayed complication of tracheocutaneous fistula closure with severe compromising subcutaneous emphysema
  1. Robert J Lewis1,
  2. Ari G Mandler2,
  3. Geovanny Perez3,4 and
  4. Pamela A Mudd5,6
  1. 1 Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  2. 2 George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  3. 3 Division of Pulmonary Medicine, Children’s National Health System, Washington, DC, USA
  4. 4 Department of Pediatrics, Pulmonary Medicine, and Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  5. 5 Division of Pediatric Otolaryngology, Children’s National Health System, Washington, DC, USA
  6. 6 Department of Pediatrics and Sugery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  1. Correspondence to Ari G Mandler, arimandler{at}gwmail.gwu.edu

Abstract

We report a significant complication after tracheocutaneous fistula (TCF) excision with closure by secondary intention in a 4-year-old boy who had been tracheostomy dependent since infancy. He had a persistent 3 mm TCF one year after decannulation. On postoperative day 2 the patient developed profound subcutaneous emphysema and pneumomediastinum. He was extubated after 2 days and discharged from the hospital on postoperative day 7. At follow up he had complete resolution of subcutaneous emphysema and complete closure of the TCF. The main methods of TCF closure and management of subcutaneous emphysema are discussed along with the lessons learned from this case.

  • otolaryngology / ENT
  • paediatric intensive care
  • paediatrics
  • pneumomediastinum
  • head and neck surgery

https://doi.org/10.1136/bcr-2019-229526

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    Footnotes

    • Contributors RJL was involved in patient care, manuscript writing and submission. AGM did manuscript writing and submission. GP: patient was under his medical care. PAM identified the case as being of particular interest, patient under her medical care and supervised. All authors involved with draft revisions and approved the final version for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The views expressed in the article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Airforce, Department of Defense or US Government.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Parental/guardian consent obtained.