Delayed Bronchoplastic Reconstruction after Traumatic Rupture and Atresia of the Right Main Bronchus: Clinical Case

Introduction. Although traumatic injuries of the tracheobronchial tree are rare, they are potentially life-threatening conditions that require early recognition and prompt surgical management. Diagnosis is frequently delayed due to subtle clinical manifestations that are often obscured by associated injuries. Up to 80% of patients die before reaching the hospital. Most injuries involve the right main bronchus and are located within 2 cm of the carina, reflecting its anatomic vulnerability. Mortality is highest in patients with bilateral bronchial injuries.

Materials and methods. We report a 34-year-old woman who sustained complete avulsion of the right main bronchus after a motor vehicle accident. The injury went unrecognized during the acute phase. One month later, bronchial atresia developed acompanied by purulent secretion and dyspnea. Delayed bronchoplastic reconstruction was performed, consisting of right upper lobectomy and end-to-end anastomosis between the right main bronchus and the bronchus intermedius. The procedure was uneventful, and the patient was discharged on postoperative day 8 without complications. Follow-up bronchoscopy at 1.5 months confirmed patent anastomosis. Contrast-enhanced computed tomography demonstrated restoration of aeration of the right lung.

Results and discussion. Tracheobronchial injuries remain uncommon yet life-threatening conditions that demand prompt diagnosis and timely surgical intervention. Main bronchial rupture in closed chest trauma typically results from combined thoracic compression and acute intrabronchial pressure rise against a closed glottis. Delayed diagnosis may lead to irreversible parenchymal damage and necessitate radical resection. Timely bronchoplastic reconstruction preserves pulmonary function, allowing pneumonectomy to be avoided.

Conclusion. This case demonstrates that successful surgical management is feasible even in the delayed post-traumatic period, provided that viable lung parenchyma is preserved and thorough preoperative assessment is performed.

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