Management of postintubation tracheal stenosis in a neurosurgical patient with tracheomalacia and scarring tendency: A case report

RATIONALE: Postintubation tracheal stenosis, a rare and life-threatening iatrogenic complication arising from the endotracheal intubation. This case is noteworthy for a very young adult with a neurosurgical background and clustered risk factors, who developed rapidly progressive high-grade subglottic/cervical tracheal stenosis with concomitant tracheomalacia. PATIENT CONCERNS: This report details a 19-year-old Han Chinese man, who is a university student, developed severe dyspnea after surgery of bilateral ventricular drainage due to cerebral hemorrhage 48 days ago. His intensive care unit course included 10 days of mechanical ventilation, gastric reflux, and bloodstream and airway infections. After first discharge, he developed recurrent, escalating inspiratory dyspnea (repeatedly misdiagnosed as pneumonia or asthma). DIAGNOSES: Lack of response to bronchodilators and steroids, absence of diffuse lower-airway process on imaging, and direct visualization of a fixed, cicatricial, high-grade subglottic stenosis on bronchoscopy together argued against alternative diagnoses including asthma, vocal cord dysfunction, and recurrent pneumonia. Grade 3 subglottic tracheal stenosis that the 6 mm bronchoscope could not pass through was confirmed by three-dimensional reconstruction computed tomography. A diagnosis of upper tracheal obstruction caused by postintubation tracheal stenosis was considered. INTERVENTIONS: Multidisciplinary consensus favored emergency laryngotracheal stenosis resection, laryngeal function reconstruction, and tracheoplasty. Successful extubation was achieved on the first postoperative day and discharged on postoperative day 10. OUTCOMES: Follow-up imaging confirmed sustained airway patency without restenosis. He achieved complete symptomatic relief, then promptly returned to the university and successfully graduated 2 years later. Until now, he has been employed full-time without functional limitations. LESSONS: In young patients with high-grade, subglottic, cicatricial stenosis and tracheomalacia, primary resection with anastomosis can be definitive when endoscopic or stent options are unsuitable in an emergency. Early warning signals (reflux, infection, post-extubation cough/stridor, and poor response to pharmacotherapy) warrant timely evaluation. Durable outcomes depend on an experienced multidisciplinary team cooperation and standardization of diagnostic, therapeutic, and follow-up pathways.