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International Journal of Otolaryngology
Volume 2011 (2011), Article ID 890380, 3 pages
http://dx.doi.org/10.1155/2011/890380
Case Report

Late Life-Threatening Hemorrhage after Percutaneous Tracheostomy

1Department of Anesthesiology and Intensive Care Medicine, Dresden University of Technology, Carl Gustav Carus University Hospital, Fetscher Street 74, 01307 Dresden, Germany
2Department of Otorhinolaryngology, Bavaria Clinic, An der Wolfsschlucht 1-2, 01731 Kreischa, Germany
3Department of Otorhinolaryngology, Dresden University of Technology, Carl Gustav Carus University Hospital, Fetscher Street 74, 01307 Dresden, Germany

Received 27 October 2010; Accepted 17 February 2011

Academic Editor: P. H. Dejonckere

Copyright © 2011 Torsten Richter et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. Formation of a tracheoinnominate artery fistula (TIF) and consecutive hemorrhage is a rare and life-threatening complication with high mortality. Warning symptoms can be absent. The current literature contains only few considerations for misleading signs, especially in cases where the contact between the tissue and the cannula is tight. Method and Results. We report two cases of life-threatening hemorrhages that appeared six days and two months after percutaneous dilatational tracheostomy (PDT) in two patients, respectively. In these cases, diagnosis of tracheoinnominate artery fistula (TIF) was difficult. Tracheal ring fracture after PDT and pressure ulceration caused by cannula were implicated in TIF formation. The cannula was overblocked to buy time before surgical closure. Both patients survived without any additional neurological deficiency. Conclusion. Massive hemorrhage in patients after tracheostomy is likely due to TIF. Ultrasound scanning before PDT and careful periodical followup of the trachea are required.