Treatment of bronchial rupture after chest trauma in children

Abstract:

Objective：To review the diagnosis and treatment of traumatic bronchial rupture in children and to discuss its appropriate managing strategy. Methods：Medical records of eight children in Children’s Hospital of Chongqing Medical University from January 2014 and January 2017 were retrospectively analyzed. Eight patients with traumatic bronchial rupture（five boys and three girls） were included，with age from 2.5 to 9.7 years old（median age of 6.5 years old） and weight of 12 to 30 kg（median weight of 22 kg）. Bronchus rupture was diagnosed through imaging studies and bronchoscopy. Among the patients，two had right bronchus rupture，and the other six had left bronchus rupture. Results：Diagnosis of the eight patients was clear after the chest CT with 3-dimensional reconstruction techniques and fibreoptic bronchoscopy. All eight patients received surgery：seven children received end-to-end bronchial anastomosis and one received surgical repair consisted of a sleeve resection（right middle lobectomy with reanastomosis of the bronchus intermedius to the right inferior bronchus）. The results were good. There was no operative death and no postoperative bronchopleural fistula. Five of the eight patients were affected with mild to moderate bronchial stenosis，without apparent respiratory symptom or atelectasis on image analysis after a follow-up up to 36 months. Conclusion：Be alert to bronchial rupture after trauma in children is helpful to the diagnosis. Chest CT with 3-dimensional reconstruction techniques and fiberoptic bronchoscopy are the most valuable diagnostic methods. Results of emergency or delayed surgery in children’s traumatic bronchial rupture are excellent.