[Traumatic rupture of a main bronchus. Clinical and peroperative presentation, physiopathological mechanisms, treatment and late sequelae]. / Traumatisk ruptur af hovedbronchus. Klinisk og peroperativ praesentation, patofysiologiske mekanismer, behandling og senfølger.

ABSTRACT

On the basis of a case report, the clinical and peroperative features of bronchial rupture caused by blunt thoracic trauma, theories concerning the pathophysiological mechanisms, the treatment and outcome are reviewed. Two distinct clinical presentations may occur (a) with free communication between the bronchus and the pleura (as in the present case) and (b) with little or no communication. The suspected diagnosis is confirmed by bronchoscopy. Peroperatively, bronchial rupture is seen at places of reduced resistance (the junction between the cartilaginous and the membranous trachea or bronchus and the annular ligaments) and typically within 2.5 cm from the carina. The pathophysiological basis includes three mechanisms decrease in the anteroposterior diameter of the thorax, sudden increase in intrabronchial pressure with a closed glottis and rapid deceleration. These mechanisms may occur independently or together. The initial treatment aims at maintaining the airway, reversing shock and relieving pneumothorax. Surgical repair should follow as soon as the condition of the patient permits. The optimal surgical technique is identical with that employed for vascular anastomoses. Surgical repair of bronchial rupture should only be omitted if extensive parenchymal pulmonary damage and/or suppuration are present. Even after years of delay, reconstruction will lead to partial recovery of pulmonary function.