気管挿管による気管膜様部損傷の1例

Tracheal Membranous Wall Injury Secondary to Endotracheal Intubation：Report of a Case

はじめに　気管挿管に伴う気管損傷はまれな合併症であるが，穿孔を伴う場合には重篤化する可能性が高い．われわれは保存的治療により良好な経過を得た気管膜様部損傷の1例を経験したので報告する．

An 81-year-old woman underwent endovascular treatment for a cerebral aneurysm under general anesthesia with intubation using a 7.0-mm endotracheal tube. Shortly after extubation, she developed hemoptysis. Bronchoscopy revealed a longitudinal laceration and bleeding of the tracheal membranous wall, extending from approximately 4-cm below the vocal cords to near the carina. Hemostasis was achieved with diluted epinephrine. Chest computed tomography （CT） showed no pneumomediastinum or perforation. Given her stable condition and that the injury was confined to the mucosal layer, conservative management was chosen. Follow-up bronchoscopy on day 5 showed healing without rebleeding or stenosis. This case highlights the importance of careful risk assessment and appropriate endotracheal tube size selection, particularly in elderly, small-framed women. It is important to develop an algorithm for selecting endotracheal tube size based on risk factors such as age, sex, and body habitus, in order to prevent tracheal injury.