A case of complete transection of right main bronchus in a child: Role of thoracoscopy and bronchoscopy
We received a 5-year-old male child from a peripheral hospital to our emergency room, with a history of run over by a bullock cart. On arrival, the child was in severe respiratory distress with absence of peripheral pulses and air entry on the right side of chest as well as un-recordable blood pressure. The child was resuscitated with crystalloids and vasopressor support.\nAn immediate bedside chest X-ray showed massive tension pneumothorax on the right side and an intercostal drain (ICD) tube was inserted []. The child was stabilized for the next 24 h, but ICD showed continuous massive air leak and the child had persistent tachypnoea. A computed tomography (CT) scan image showed a collapse lung and massive pneumothorax with a suspicion of right main bronchus injury.\nThe child was taken to the operating room. After intubation with single lumen endotracheal tube, a fiber optic bronchoscopy showed right mainstem bronchus obliteration by hematoma just 1.5 cm from carina, and the endotracheal tube was guided into left main bronchus. A diagnostic thoracoscopy was done to reveal complete transection of the right main bronchus and no associated mediastinal injuries [].\nA right postero-lateral thoracotomy showed bronchial transection about 1.5 cm from the carina []. The distal end was dissected out from the hilar structures and bronchial continuity was established by an end-to-end anastomosis with 4-0 vicryl interrupted sutures. The child was extubated and was in intensive care unit (ICU) with oxygen support. Early postoperative chest X-ray showed features of pneumonitis, which resolved with intravenous (IV) antibiotics and chest physiotherapy, with complete lung expansion seen on chest X-ray [].