In a rare surgery, doctors at the All India Institute of Medical Sciences (AIIMS) have reconstructed a food pipe and repaired a tracheobronchial injury of an 18-year-old youth from Patna, who had met a serious accident. The patient had sustained chest injuries when a tractor trolley overturned on his body in November last year.
At first, the patient was admitted to a private hospital in Patna. It was only after four days that he was allowed to consume food, he complained of persistent cough, difficulty in breathing and swallowing. “An upper gastro-intestinal endoscopy was performed which showed a complex disruption and communication between the wind and food pipes and also the junction of the wind pipe with two main bronchus of either lung. Any attempt of maintaining the airway of patient by tube or positive ventilator could have further disrupted the injury leading to immediate death,” said AIIMS Director, MC Mishra.
The patient was referred to AIIMS and was admitted to the Trauma Centre on November 19, two weeks after the accident. “A contrast enhanced CT scan of the chest and abdomen was done at the Trauma Centre which further revealed the complexity of the injury, showing a long communication between the trachea, both bronchi and esophagus. He also had fracture in sternal bone and lungs showed aspiration changes following injury,” said Mishra.
The trauma surgeons and anesthetists then contemplated on the ways to repair the injury. Doctors said that since it was complex and had a difficult approach, any attempt to give general anesthesia to the patient and positive pressure ventilation during anesthesia could have further disrupted the tracheo-bronchial junction leading to catastrophic consequences.
Meanwhile, the patient was put on an intravenous nutrition. “The various surgical options were discussed between the teams and finally it was decided that the surgery would be performed after taking the patient on a cardio-pulmonary bypass so that the heart and lung function could be done by the bypass machine till the time surgery was performed,” added Mishra.
This obviated the need of positive pressure ventilation during surgery. “On November 24 last year the patient was taken up for surgery in cardiac surgery operation theatre. After the cardiac surgeon put the patient on bypass and opened the chest to give access, SC Sharma (ENT Surgeon) repaired the trachea and bronchus. Then the surgery on neck and abdomen was done respectively to divert the food pipe from the fistula site. Finally the neck, chest and abdominal wound were closed with temporary diversion of food pipe in the neck,” said Amit Gupta, Additional Professor of Trauma Surgery.
The surgery took five and half hours and the duration of bypass was 220 minutes. The patient was discharged and will now undergo restoration, doctors said.