RESUMEN
Se han descrito diversas técnicas para el tratamiento del enfisema subcutáneo y del neumomediastino. Algunos pacientes con pequeñas perforaciones traqueales pueden ser manejados de forma expectante, salvo que requieran ventilación mecánica. Se presentan las imágenes de un paciente con enfisema subcutáneo y neumomediastino no candidato a cirugía y quien fue tratado exitosamente con terapia de presión negativa.
Different techniques have been described for the treatment of subcutaneous emphysema and pneumomediatinum. Some patients with small tracheal perforations can be managed expectantly, unless they require mechanical ventilation. Images of a patient with subcutaneous emphysema and pneumomediastinum not a candidate for surgery and who was successfully treated with negative pressure therapy are presented.
Asunto(s)
Humanos , Enfisema Subcutáneo , COVID-19 , Tráquea , Ventiladores de Presión Negativa , Enfisema MediastínicoRESUMEN
Airway perforation is a rare but potentially fatal complication following laser surgery. A 66 years old man was admitted for surgery of tracheal stenosis. He had undergone 2 prior anesthesia for similar surgery and had diabetes mellitus due to chronic steroid therapy. 2 hours after surgery, tracheal perforation lead to pneumomediastinum, tension pneumothorax and perforation of innominate artery with potential risk to injury, which lies in the close proximity to perforation site of trachea. Arterial wall was so weak and fragile that it was difficult to repair the ruptured site. During the procedure, hemorrhage persisted and cardiac arrest developed. Immediate CPR(cardiopulmonary resuscitation) with internal cardiac massage was done but the patient did not recover. We believe that in patient with history of multiple operations, chronic steroid therapy and diabetes mellitus, the vascular structure of thin and fragile should be approached with greater caution when using CO2 laser during surgery.