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Lung preservation in a case of complex rupture of right main bronchus and segmental bronchi injury with lung laceration

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Abstract

Repairing complex bronchial injury is challenging. We present a case of successful bronchial repair with preservation of the entire lung in a complex bronchial injury. An 18-year-old male presented with pneumothorax and minimal dyspnea following blunt chest trauma and was managed with intercostal drainage and resuscitation. A review after 48 h showed a fallen lung sign with a Cerfolio 4C air leak. Computed tomography (CT) scan confirmed the right main bronchial injury. On exploration, a lacerated consolidated right upper lobe with dusky discoloration was noted. Longitudinal avulsion of 2/3rd of the anterior wall of the right main bronchus (RMB) at the level of the upper lobe bronchus, extending up to the segmental bronchi of the upper lobe, causing complete disruption of the confluence of secondary bronchi was noted along with disruption of the bronchus intermedius. Three segmental bronchi of the upper lobe were sutured together into a common confluence and reimplanted on the RMB. The anterior wall of the RMB and the bronchus intermedius were repaired and reinforced with an intercostal flap. The parenchymal laceration was repaired. Serial chest radiograph showed complete expansion of the middle and lower lobes with gradual improvement of the upper lobe. Check bronchoscopy showed a healthy repair margin with partial stenosis in the anterior and posterior segmental bronchi. Following bronchoscopy and lavage, upper lobe air entry improved with a residual wedge of consolidation of the upper lobe on discharge. Four months follow-up showed improved lung status with no symptoms. In our case, lung preservation was considered as the patient was young and did not have any features of sepsis and there was no history of primary lung disease. Lung preservation should be considered whenever feasible in complex bronchial injuries.

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Supporting data is available as Fig. 1, Fig. 2 and Fig. 3 as a part of this record.

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Authors and Affiliations

  1. Department of CTVS, IPGMER & SSKM Hospital, Kolkata, India

    Nabarun Mallick, Prakash Sanki, Jayita Chakraborty & Subhendu Sekhar Mahapatra

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  1. Nabarun Mallick
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  2. Prakash Sanki
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  3. Jayita Chakraborty
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  4. Subhendu Sekhar Mahapatra
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nabarun Mallick and Prakash Sanki. The first draft of the manuscript was written by Nabarun Mallick and all authors commented on previous versions of the manuscript. Subhendu Sekhar Mahapatra and Jayita Chakraborty revised the work critically for important intellectual content; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published. All authors read and approved the final manuscript.

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Correspondence to Nabarun Mallick.

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No ethical committee approval is required as per institutional guidelines and the authors have maintained complete confidentiality of the patient in every possible way and reporting has been done in accordance with ethical standards. Written informed consent was obtained before surgery.

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Written informed consent was obtained from the participant included in this study. Additional informed consent was obtained for publication of images and submission of this case series to the journal.

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The authors have no relevant financial or non-financial interests to disclose.

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Mallick, N., Sanki, P., Chakraborty, J. et al. Lung preservation in a case of complex rupture of right main bronchus and segmental bronchi injury with lung laceration. Indian J Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s12055-024-01702-z

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  • DOI: https://doi.org/10.1007/s12055-024-01702-z

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