Free intraabdominal air following an isolated gunshot injury to the trachea
Brinkmann, M.; Singbartl, G.; Jaspers gen Bünger, U.
Der Anaesthesist 39(2): 113-116
1990
ISSN/ISBN: 0003-2417 PMID: 2310002 Document Number: 364477
This case report describes a 21-year-old male patient suffering from a close-range suprajugular blank-cartridge injury, i.e. a gunshot injury without a projectile. On arrival at the hospital a cutaneous lesion of 5 mm in diameter was seen 2 cm above the jugular notch with traces of gunpowder in the surrounding skin. The cardiovascular status and spontaneous breathing were sufficient. On attempts to answer questions air was seen to escape from the lesion, indicating a tracheal defect. The patient was rapidly intubated and subjected to further diagnostic procedures. A chest X-ray film revealed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and marked subcutaneous emphysema of the chest and abdominal wall. After insertion of bilateral chest tubes, both lungs promptly reinflated and no air leakage could be demonstrated. As free intra-abdominal air has its source in a ruptured viscus in about 90% of cases, close attention was paid to possible abdominal symptoms. Contrast radiography and computer tomography (1st postoperative day) failed to demonstrate intestinal rupture. As there was no clinical evidence of peritonitis, exploratory laparotomy was not performed. Revision of the cervical lesion revealed locally extended destruction of tissues, including the pyramidal thyroid lobe and the anterior tracheal wall. After anastomosis of the trachea the endotracheal tube was left in place as an intraluminal splint for 8 days. Bronchoscopy at this time showed no evidence of tracheal stenosis and the patient was extubated. Two days later he left the hospital. The underlying pathophysiological mechanisms of free intra-abdominal air in the absence of gastrointestinal lesions are discussed and the literature is reviewed.