Tracheal Fracture and Stenosis Secondary to Sidewall-Inserted Percutaneous Dilatational Tracheostomy: A Case Report

Tracheal stenosis may occur as a complication of tracheostomy regardless of technique; however, it is more frequently observed with percutaneous dilatational tracheostomy (PDT) than with surgical tracheostomy (ST). We report a case of a patient with severe tracheal stenosis due to a tracheal ring fracture and intratracheal granulation caused by PDT puncture through the lateral tracheal wall. A 62-year-old male underwent PDT after a vehicular accident. He was decannulated after 2 months but developed dyspnea and underwent PDT again. Bleeding occurred every tracheostomy tube exchange, and tube reinsertion was difficult; hence, the patient was referred to our institution for management. Endoscopy showed tracheal medial compression, long and deep tracheocutaneous fistula, and multi-level intratracheal granulation, particularly at the point of distal tube contact. Immediate ST and endoscopy-guided excision of the granulation tissue using electrocautery were performed. Healing of the tracheal fistula and improvement in stenosis were noted after 1 week. The tracheal stenosis was stable for 6 months with full epithelialization of the latest tracheostomy site. PDT is a straightforward and widely practiced method, but careful assessment of its indications and proper execution of the procedure are crucial. Careful evaluation of the indication for PDT and meticulous surgical performance are vital to prevent potential complications such as tracheal stenosis.