Main Article Content
Introduction: The trachea is a semiflexible tube of 1.5 to 2 cm in width and 10 to 13 cm in length. Its deviation might be caused by not only diverse thoracic but also abdominal pathologies, which may compromise the airway. We present a case of a severe tracheal deviation due to an abdominal pathology causing displacement of mediastinal structures.
Clinical Case: A 78-year-old woman presents with difficulty breathing. History of chronic bedridden and frequently constipated, last stool 5 days prior. On physical examination, cachectic complexion, dry mucous membranes, breathing superficially with scarce wheezing, SatO2 82% on room air. Abdomen distended with an absence of bowel sounds. Chest x-rays show severe tracheal deviation and abdominal x-ray with coffee bean sign. A laparotomy evidences a large sigmoid volvulus. A sigmoidectomy and descending colon colostomy is performed. Room air oxygen saturation improved after extubation to 96%.
Conclusion: Desaturation and tracheal deviation were caused by a large sigmoid volvulus. Although these pathologies were thoracic, clinicians should suspect different underlying pathologies, in this case, abdominal.
Anaya-Ayala, J. E., Naik-Mathuria, B., & Olutoye, O. O. (2008). Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. Journal of pediatric surgery, 43(3), E35–E39. https://doi.org/10.1016/j.jpedsurg.2007.11.015
Brand-Saberi BEM, Schäfer T. Trachea (2014): Anatomy and physiology. Thorac Surg Clin.;24(1):1-5. 10.1016/j.thorsurg.2013.09.004
Chandra P, Schmidt RM, Madan P, Topkara VK. (2008) Mediastinal sarcoma with deviated tracheal anatomy. J Thorac Oncol. 3(1):82-83. https://doi.org/10.1097/JTO.0b013e31815ba2b5
Fox, Charles J., III, Cornett, Elyse M., Ghali, G.E. (2019). Catastrophic Perioperative Complications and Management: A comprehensive textbook. Switzerland: Springer.
Edwards DS, Davis I, Jones NA, Simon DW. (2014) Rapid tracheal deviation and airway compromise due to fluid extravasation during shoulder arthroscopy. J Shoulder Elb Surg.23(7):e163-e165. 10.1016/j.jse.2014.03.006
Ghai A, Hooda S, Wadhera R, Garg N. (2011) Gross tracheal deviation: Airway challenges and concerns - Two case reports. Acta Anaesthesiol Belg.
Greene A, Gaver R. (2013) Tracheal deviation secondary to massive cardiomegaly in a two month old child with newly diagnosed total anomalous pulmonary venous return. J Clin Anesth.25(7):602-603. 10.1016/j.jclinane.2013.04.016
Kang, B. Y., Sioda, N., Rahma, A., Ali, M., Zhao, X., & Anzalone, T. (2020). Mediastinal Shift due to Obstipation from Sigmoid Adenocarcinoma. American journal of respiratory and critical care medicine, 202(7), e113–e116. https://doi.org/10.1164/rccm.201910-1953IM
Khajotia R. (2012). Respiratory Clinics: MEDIASTINAL SHIFT: A SIGN OF SIGNIFICANT CLINICAL AND RADIOLOGICAL IMPORTANCE IN DIAGNOSIS OF MALIGNANT PLEURAL EFFUSION. Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia, 7(1), 34–36.
Kim HJ, Choi YS, Park SH, Jo JH. (2016) Difficult endotracheal intubation secondary to tracheal deviation and stenosis in a patient with severe kyphoscoliosis -a case report. Korean J Anesthesiol.;69(4):386-389. https://doi.org/10.4097/kjae.2016.69.4.386
Kiyaka, S. M., Sikakulya, F. K., Masereka, R., Okedi, X. F., & Anyama, P. (2021). Sigmoid volvulus in an adolescent female: A case report. International journal of surgery case reports, 87, 106430. https://doi.org/10.1016/j.ijscr.2021.106430
Lal, S. K., Morgenstern, R., Vinjirayer, E. P., & Matin, A. (2006). Sigmoid volvulus an update. Gastrointestinal endoscopy clinics of North America, 16(1), 175–187. https://doi.org/10.1016/j.giec.2006.01.010
Lou, Z., Yu, E. D., Zhang, W., Meng, R. G., Hao, L. Q., & Fu, C. G. (2013). Appropriate treatment of acute sigmoid volvulus in the emergency setting. World journal of gastroenterology, 19(30), 4979–4983. https://doi.org/10.3748/wjg.v19.i30.4979
Mallat J, Robin E, Pironkov A, Lebuffe G, Tavernier B. (2010) Goitre and difficulty of tracheal intubation Goitre et difficulte. Ann Fr Anesth Reanim;29(6):436-439. 10.1016/j.annfar.2010.03.023
Perri B, Cooper M, Lauryssen C, Anand N. (2007) Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion: a case study. Spine J.;7(2):235-239. 10.1016/j.spinee.2006.04.010
Prada LR. (2017) A Case of a Rapidly Enlarging Neck Mass with Airway Compromise. J Clin Diagnostic Res.;11(5):14-16. 10.7860/JCDR/2017/25685.9874
Quiroga‐Garza, A., Teran‐Garza, R., Elizondo‐Omaña, R. E., & Guzmán-López, S. (2020). The Use of clinical reasoning skills in the setting of uncertainty: a case of trial femoral head migration. Anatomical Sciences Education, 13(1), 102-106.
Sabri Selcuk Atamanalp. (2020). Sigmoid volvulus: An update for Atamanalp classification. Pakistan Journal of Medical Sciences, 36, 1137-1339.
Shepard J-AO, Flores EJ, Abbott GF. (2018) Imaging of the trachea. Ann Cardiothorac Surg.;7(2):197-209. 10.21037/acs.2018.03.09
Sivasankaran, S., Kawamura, A., Lombardi, D., & Nesto, R. W. (2006). Gastric volvulus presenting as an acute coronary syndrome. Texas Heart Institute journal, 33(2), 266–268.
Zhao Z, Zhang T, Yin X, Zhao J, Li X, Zhou Y. Update on the diagnosis and treatment of tracheal and bronchial injury. J Thorac Dis. 2017;9(1):E50-E56. 10.21037/jtd.2017.01.1