Rare Delayed Tracheal Perforation after Total Thyroidectomy Repaired With Autologous Pericardial Pacth A Case Report

Abstrak

Background: Thyroidectomy is a general surgical procedure that is very common with 3–5% complication rate. Tracheal perforation after thyroidectomy is rare at 0.06%, and is usually identified and repaired intraoperatively. Delayed tracheal perforation is even rarer, with only few cases reports with different management.^1–3

Case illustration: We report a case of a 57-year-old female who underwent total thyroidectomy for infiltrating bilateral thyroid cancer. Tumor infiltration to the trachea was shaved, followed by tracheostomy to secure the airway. Perforation symptoms appear on day 4 after the patient experienced choking in the form of progressive slem production. Perforation was found in the shaven area fused to the tracheostomy hole sized 2x3 cm. The patient was managed in stages, initially with debridement and antibiotics followed by surgical repair. Tracheal repair surgery performed an autologous pericardial pacth combined with a PTFE vascular implant. The patient was extubated 1 week after repair and discharged alive. No further complications on follow-up.

Discussion: In this case, perforation happened due to mechanical force on the remaining thin shaved tracheal wall during choking. Autologous pericardial patch was used due to its several advantages combined with PTFE vascular implant as rigid stenting that prevent colaps when breathing.

Conclusion: Autologous pericardial patch combined with PTFE was sufficient to close delayed perforated trachea after thyroidectomy.