Journal of Anesthesiology and Pain

Aim and Background: Percutaneous tracheostomy, a common surgical procedure in the field of otolaryngology, is associated with complications, such as bleeding, infection, subcutaneous emphysema, pneumothorax, recurrent laryngeal nerve injury and tracheal ring fracture. However, the incidence of pneumothorax and pneumoperitoneum in a single individual is rare. 

 Case report: A 70-year-old woman was scheduled to undergo an urgent tracheostomy with dyspnea and severe respiratory distress due to incomplete superior airway obstruction following relapse of medulary thyroid cancer. Approximately two minutes after insertion of the tracheostomy tube, her blood pressure and O₂ saturation decreased but airway pressure increased. Physical examinations revealed decreased bilateral breath sounds and diffuse expansion of the abdomen. Immediately an orotracheal tube was inserted up to 10 cm through the orifice of tracheostomy into the trachea. After puncture of the chest and abdomen the air was evacuated and the patient was discharged from ICU after 2 days hospitalization without any adverse event. The proposed mechanisms include: complications related to lack of proper placement of tracheostomy tube due to tumor location, tube dislocation, and barotrauma .Rupture of alveolar walls or bronchial and bronchioles lead to air leakage into the pleural cavity and can cause pneumothorax. Although the thoracic and peritoneal cavities are separated by the diaphragm, they may communicate through congenital defects, such as a pleuroperitoneal canal or defects adjacent to the aorta or esophagus.

Conclusions : Performing tracheostomy, especially in patients with a cervical mass, can be associated with serious and life-threatening events. Attention to the risk of these complications and prompt treatment would reduce the mortality and morbidity rate.