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Fatal hemorrhage from tracheoarterial fistula after tracheostomy Report of three cases and a clinical review
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Abstract: (18886 Views) |
| Introduction: Tracheo–innominate artery fistula (TIF) is a rare but fatal complication of tracheostomy with an incidence of one out of every 150 tracheostomies, which almost always results in death without immediate surgical intervention. In such cases forensic pathologist may be called for an autopsy to determine cause of death and any probable medical or surgical negligence. So their familiarity with this complication of tracheostomy is necessary.
Case report: In this article we present three fatalities due to hemorrhage from the tracheostomy site, which were referred to Mashad Legal Medicine Center two for autopsy and one for determining any probable medical negligence. A clinical review article is followed.
Discussion: pressure necrosis from high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, radiotherapy, prolonged intubation, excessive head and neck movements, and innominate artery anomalies are all implicated in TIF formation. Massive hemorrhage occurring 3 days to 6 weeks after tracheostomy is a result of TIF until proven otherwise. When this happens, one must tampon the bleeding vessel by overinflating tracheostomy tube cuff or by digital compression of vessel against sternum via tracheostomy stoma, while transferring the patient to the operating room. The mainstay of surgical treatment is to terminate flow within the innominate artery by debriding and transecting it. As a result of their small size, post-mortem diagnosis of TIF can be difficult until specifically searched for by forensic pathologist. |
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| Keywords: Tracheostomy, Tracheoinnominate Artery Fistula, Hemoptysis |
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Full-Text [PDF 884 kb]
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Type of Article: Case Report |
Received: 2009/04/11 | Revised: 2009/05/6 | Accepted: 2018/03/29 | ePublished: 2018/03/29
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