AIIMS doctors repair rupture in windpipe, foodpipe

An 18-year-old youth, who suffered a grievous injury in his windpipe and foodpipe that created disruption in breathing and swallowing, underwent a complex surgery successfully at AIIMS here, hospital authorities said Tuesday.

Niti Kumar from Patna sustained injuries on his chest after a tractor-trolley over turned Nov 5, 2014.

He was initially admitted to a Patna-based private hospital where a "complex disruption between the windpipe and the foodpipe and also in the junction of the windpipe with two main bronchus" was found during a gastrointestinal endoscopy.

According to doctors, any attempt at maintaining the air passage through a tube or a ventilator could have worsened the injury, leading to immediate death.

Looking at the risk involved, the patient was referred to the Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS).

The patient arrived at the trauma centre Nov 19, 2014. A CT scan of his chest and abdomen was done which revealed a major rupture of the wall between the foodpipe and the windpipe.

"The patient also had fracture of sternal bone and his lungs showed aspiration changes following the injury," said the authorities.

A team of doctors from departments like ear-nose-throat (ENT), cardiothoracic, cardiology and medicine was formed to treat the injury.

"Any attempt to give positive pressure ventilation during anaesthesia could further disrupt the 'tracheo-bronchial' junction, leading to catastrophic consequences," M.C. Misra, director, AIIMS, said at a press conference Tuesday.

According to doctors, the patient was also malnourished and they had to wait for some days to bring him to a stage where he could undergo surgery.

The team members discussed various surgical options and decided that the surgery would be performed after taking the patient on a cardio-pulmonary bypass so that his heart and lungs could function through the bypass machine during the surgery.

"This would obviate the need of positive pressure ventilation during surgery," said S.C. Sharma, head, ENT department, AIIMS.

"The patient was operated upon Nov 24, 2014 for over five and half hours. The chest of the patient was opened to repair his trachea and bronchus," Sharma told reporters.

Though the patient has been discharged, he will again have to undergo a restoration and reconstruction surgery of the foodpipe, he said.