食道静脈瘤チューブの気道内誤挿入によると思われる医原性気管支損傷

Iatrogenic Injury of the Bronchus Suspiciously Caused by Sengstaken-Blakemore Tube into the Airway

気管・気管支損傷は比較的まれな外傷であるが，症状が重篤かつ進行性で致死率が高く，救命のためには迅速かつ的確な診断・治療が求められる．気管・気管支損傷の多くは手術による損傷部位の修復が必要とされているが，小裂傷の場合には気道内の減圧などの保存的治療で治癒することもある．われわれは医原性左主気管支膜様部裂傷が保存的治療で治癒した症例を経験したので報告する．

Background：Tracheobronchial injury is often operated urgently because of the risk of high mortality. However, small injuries can recover by conservative management.

Case：A 65-year-old man was treated for esophageal varix with transcatheter arterial embolization therapy. He vomited blood and endoscopic sclerotherapy was performed because a Sengstaken-Blakemore tube could not be inserted. Thereafter, computed tomography （CT） detected mediastinal emphysema and an injury to his left main bronchus. The patient consulted our department and bronchoscopy detected a laceration of the left main bronchus. Conservative management was chosen because the laceration was limited to the membranous portion, with the improvement of inflammatory reaction. Several weeks later, CT and bronchoscopy confirmed recovery from the injury of the left main bronchus without stricture.

Conclusion：An operation is indicated for many tracheobronchial injuries. However, some injuries can recover with conservative management. It is important that indication for surgery should be considered based on bronchoscopic findings and the progress of inflammatory reaction.