A Case of Pneumomediastinum and Pneumoperitoneum with Concurrent Massive Subcutaneous Emphysema due to Repositioning of a Tracheostomy Tube

Tracheostomy is a common procedure seen in critically ill patients that require long term ventilatory support. As with all airway access procedures, tracheotomy with prolonged tracheal tube placement comes with possible risks such as tracheal scarring, tracheal rupture, pneumothorax, tracheoesophage...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2019-01, Vol.11 (1), p.e3881
Main Authors: Elkholy, Karim O, Akhtar, Hamza, Landa, Eric, Malyshev, Yury, Sahni, Sonu
Format: Article
Language:English
Subjects:
Abdomen
Case reports
Emergency Medicine
Emphysema
Endoscopy
Etiology
Gas absorption
Intensive care
Internal medicine
Medical imaging
Nitrogen
Nursing homes
Ostomy
Otolaryngology
Patients
Pulmonology
Tomography
Ventilators
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Summary:Tracheostomy is a common procedure seen in critically ill patients that require long term ventilatory support. As with all airway access procedures, tracheotomy with prolonged tracheal tube placement comes with possible risks such as tracheal scarring, tracheal rupture, pneumothorax, tracheoesophageal fistula among others. Another possible complication, though rare, is escape of free air into the surrounding tissue, as well as pneumomediastinum (PM). This may occur due to various reasons, some of them being tracheal rupture, barotrauma or tracheal tube mispositioning. Pneumomediastinum may present with concurrent free air in other body cavities such as the peritoneum, thorax or subcutaneous tissue. Though often not life-threatening it may require treatment including high flow oxygen, ventilator management or occasionally, surgical intervention. Herein we describe a rare case of PM with communicating pneumoperitoneum and massive subcutaneous emphysema due to tracheal tube mispositioning along with a review of the literature.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.3881