[A case report of surgically treated tracheobrachiocephalic artery fistula following tracheostomy].
The patient was a 17 year-old-boy with mental retardation and cerebral palsy, who underwent tracheostomy because of tracheobronchomalacia and tongue swallowing three months ago. After minimal tracheostomy bleeding was noted for a few days, massive hemorrhage occurred suddenly. The patient was severely hypotensive. The cuff on the tracheostomy tube was hyperinflated, which stopped the bleeding temporarily. Through a median sternotomy and collar incision, a pin hole-sized defect in the medial surface of the brachiocephalic artery at the tracheal balloon was repaired by suture. The tracheal defect allowed visualization of the tracheal cannula balloon. The pectoralis major muscle flap was interposed between the tracheal defect and the artery. The tracheal defect was packed with muscle. Seven days after the operation, the second operation was done for recurrent bleeding. The defective segment of brachiocephalic artery was resected and the ends were oversewn with monofilament sutures. Continuous irrigation with povidone-iodine solution was continued for purulent mediastinitis. We believe that interruption of blood flow of the brachiocephalic artery, interposition and packing of muscle flap over the tracheal defect and continuous irrigation for infection were effective treatment of choice.
Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Japan.
Y
Y
Terada
K
K
Yamabuki
T
T
Fukushima
R
R
Sumazaki
K
K
Hamano
H
H
Takita
T
T
Mitsui
M
M
Hori
D000293:Adolescent; D016122:Brachiocephalic Trunk; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D012086:Reoperation; D013524:Surgical Flaps; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects*; D014652:Vascular Diseases / Q000209:etiology / Q000601:surgery