Entübasyon Sonrası Trakeal Rüptür Gelişen Hastanın Perioperatif Yönetimi
Özet
Endotrakeal entübasyonun nadir fakat ciddi bir komplikasyonu olan iyatrojenik trakeal rüptür, yüksek morbidite ve mortalite riski taşımaktadır. Bu vaka sunumunda, endometriozis cerrahisi sonrası üçüncü saatte dispne ve yaygın cilt altı amfizem gelişen 40 yaşındaki kadın hasta ele alınmaktadır. Toraks BT ve bronkoskopi incelemeleri sonucunda, trakeanın posterior duvarında 4 cm'lik bir rüptür saptanmıştır. Hastanın perioperatif yönetiminde, rüptür bölgesinin distalinde konumlandırılan tek lümenli tüp ile koruyucu mekanik ventilasyon stratejileri uygulanmıştır. Cerrahi onarım, transservikal yaklaşımla çevre dokular ve fibrin yapıştırıcılar kullanılarak başarıyla gerçekleştirilmiştir. Postoperatif dönemde yoğun bakımda takip edilen hasta, klinik stabilitenin sağlanmasıyla taburcu edilmiş ve bir ay sonraki kontrolünde tamamen iyileştiği gözlenmiştir. Bu vaka, özellikle obezite ve kısa boy gibi risk faktörlerine sahip hastalarda, entübasyon sonrası gelişen cilt altı amfizem gibi belirtilerin erken tanınmasının hayati önemini vurgulamaktadır. Erken teşhis, uygun hava yolu yönetimi ve zamanında cerrahi müdahale, trakeal rüptür vakalarında başarılı sonuçların anahtarıdır.
Iatrogenic tracheal rupture, a rare but serious complication of endotracheal intubation, carries a high risk of morbidity and mortality. This case report discusses a 40-year-old female patient who developed dyspnea and widespread subcutaneous emphysema three hours after endometriosis surgery. Thoracic CT and bronchoscopy revealed a 4 cm rupture in the posterior wall of the trachea. In the perioperative management, protective mechanical ventilation strategies were implemented using a single-lumen tube positioned distal to the rupture site. Surgical repair was successfully performed via a transcervical approach using surrounding tissues and fibrin glues. The patient, monitored in the intensive care unit postoperatively, was discharged after achieving clinical stability, and a full recovery was observed at the one-month follow-up. This case emphasizes the vital importance of early recognition of symptoms such as subcutaneous emphysema following intubation, especially in patients with risk factors like obesity and short stature. Early diagnosis, appropriate airway management, and timely surgical intervention are key to successful outcomes in tracheal rupture cases.
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