Case report of successful management of intraoperative tracheal rupture during thoracoscopic esophageal resection in patient with esophageal cancer

INTRODUCTION: A rupture of the membranous part of trachea during thoracoscopic and transhiatal resection of esophagus is a rare complication that occurs in 0.4% of cases. This complication often requires thoracotomy and is associated with prolonged pulmonary ventilation, long-term pleural draining due to persistent air leakage and development of a tracheopleural fistula, prolonged hospitalization, and high risk of septic and secondary cardiorespiratory complications. PRESENTATION OF CASE: A 52-year-old woman complained of difficulty eating solid food, impaired swallowing, persistent pain behind the sternum, nausea, sickness and weight loss. EGD revealed tumor almost completely obturating the lumen in the middle third of the esophagus. The histopathological examination showed esophageal SCC. CT scan confirmed 33 × 29 × 55 mm tumor. The patient underwent thoracoscopic esophageal resection during which two defects of the tracheobronchial tree with sizes of 15 mm and 30 mm were detected and then successfully sewn using intracorporeal continuous Stratafix 3.0 suture. The patient was diagnosed with cancer of middle third of esophagus pT3N1M0, stage IIIB. DISCUSSION: Thorough selection of patients undergoing thoracoscopic esophageal resection together with gentle manipulations with the esophagus in the area adjacent to the trachea can prevent intraoperative tracheobronchial damages. Timely diagnosis of such serious complications makes it possible to successfully manage them using thoracoscopic techniques. CONCLUSION: Intraoperative tracheal and bronchial ruptures can be successfully managed with thoracoscopic intracorporeal suture.