WOFAPS 2025 8th World Congress of Pediatric Surgery

Servet Melike Akıncı ¹, Tunç Tığlı ¹, MUSTAFA ÜNAL SAYILIR ¹, Berna Oğuz ², Filiz Üzümcügil ³, Selman Kesici ⁴, Şafak Alpat ⁵, İdil Rana user kılıç ¹

¹ Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkiye
² Hacettepe University, Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Ankara, Turkiye
³ Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkiye
⁴ Hacettepe University, Faculty of Medicine, Department of Pediatric Intensive Care Unit, Ankara, Turkiye
⁵ Hacettepe University, Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Turkiye

Background: Pediatric tracheobronchial injuries are extremely rare and potentially life-threatening. The absence of pediatric-specific treatment guidelines often leads to the application of adult-based surgical approaches. However, conservative management may be a viable alternative in selected cases.

Case Presentation: A 7-year-old boy from a rural farming village sustained thoracic impalement after falling onto a 30 cm iron rod. The rod penetrated the left chest wall through the third intercostal space at the midclavicular line. Initial management at a local health facility included wound closure. Thoracic computed tomography revealed a left-sided pneumothorax, massive pneumomediastinum, and a 2 cm laceration near the origin of the left main bronchus. The patient presented with respiratory failure and was intubated and transferred to our ICU on mechanical ventilation. After extubation on post-trauma day 5, chest imaging showed total left lung collapse and recurrent pneumothorax, although the patient remained clinically stable. Follow-up CT demonstrated minimal pneumomediastinum and narrowing of the distal bronchus, likely due to a mucus plug or hematoma. A multidisciplinary decision was made to perform bronchoscopy. Surgical teams were alerted, and venovenous ECMO was prepared. Bronchoscopy revealed granulation tissue and mucosal healing without airway defect or stenosis. Non-invasive positive pressure ventilation was initiated, resulting in complete resolution of atelectasis. The patient was discharged on post-trauma day 20 without the need for surgery.

Conclusion: This case demonstrates that in selected pediatric bronchial injuries, conservative management can be a safe and effective alternative to surgery. Bronchoscopy, combined with careful clinical monitoring, may confirm airway healing, avoid unnecessary thoracic exploration, and reduce morbidity.