Endoscopic treatment of intermediate bronchus rupture in a 4-year-old child with polytrauma

BACKGROUND: In the structure of childhood traumatism, thoracic trauma occurs in less than 10% of cases, but it is the second most likely cause of death in children. A bronchial rupture that disrupts adequate ventilation of the lungs can be the culprit of the fatal outcome. The purpose of our publication is to demonstrate a rare clinical observation of successful endoscopic treatment of an intermediate bronchus rupture in a 4-year-old child with polytrauma. CLINICAL CASE DESCRIPTION: A 4-year-old boy was injured in a traffic accident as a pedestrian. During the first three days, he was treated for multiple injuries (Injury Severity Score 41) in a local hospital where, because of emergency indications, drainage of the right pleural cavity with two drains for tension pneumothorax and laparotomy for intra-abdominal bleeding due to liver rupture were done. Because of patient’s relative stabilization by the 3rd post-trauma day, he was transferred to our clinic (level 1 trauma center). We could stabilize his hemodynamics; however, air blowing through the drains was maintained, complete straightening of the parenchyma of the right lung was not reached, and blood gas composition remained subcompensated. On day 5 of the post-traumatic period, laryngotracheobronchoscopy was performed, and the rupture of intermediate bronchus measuring 3×9 mm was diagnosed. Its occlusion with a positive effect was done. After 7 days, laryngotracheobronchoscopy was repeated, and blockers were removed. After that, complete straightening of the right lung was reached; no recurrence of bronchopulmonary fistula. Long mechanical ventilation and long hospital stay were results of severe traumatic brain injury. At the follow-up visit in a year, no pathology in respiratory organs was detected at clinical laboratory, radiological and endoscopic examination. CONCLUSION: Bronchial rupture may be a cause of inadequate ventilation and aggravation of the post-traumatic period in a polytrauma patient. The present observation demonstrates that intraluminal endoscopy allows to timely detect the rupture of the large bronchus and to perform a minimally invasive surgical treatment. Such a tactics ensured further positive dynamics in child's condition and favorable outcomes after polytrauma, as a whole.