La sténose trachéale sévère post-intubation prolongée

The rate of post-intubation tracheal stenosis (PITS) varies from 10 to 22% according to the studies. Only 1-2% of these stenoses are severe or symptomatic and manifest as inspiratory dyspnea that doesn't improve under corticosteroid treatment. STPI often occurs in patients with altered general status and this complicates their management. We report the case of a 43-year old hypertensive patient with a 1-year history of haemorrhagic stroke due to hypertensive peak, who had been in a coma for 3 months, requiring prolonged intubation and tracheotomy. Tracheal cannula removal had been proven time and again, but it was impossible due to respiratory distress. ENT exam showed important subglottic stenosis above the hole due to tracheotomy. Ct scan confirmed tracheal stenosis (A, B, C). Tracheoscopy under general anesthesia objectified subglottic stenosis at 1 cm from the glottic floor. The patient underwent surgery with proximal tracheal resection of 3cm, posterior cricoid mucosectomy and cricotracheal anastomosis. Postoperative outcome was favorable. The diagnosis of PITS is sometimes difficult, but it should be suspected in any patient with dyspnoea of recent onset or with unusual dyspnoea after intubation and/or tracheotomy. Tracheal resection and anastomosis, as they have been performed in our study, are the treatment of choice for tracheal stenosis.