Journal of Surgical Technique and Case Report
Journal of Surgical Technique and Case Report


 
  Table of Contents 
CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 54-55  

The use of t-tube cholangiocatheter stents in the treatment of pediatric tracheomalacia


1 Department of Pediatric Surgery and Urology, Hormozgan and Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Gastroenterohepatology Research Center, Shiraz University of Medical Sciences and Member of Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
3 Department of Gastroenterohepatology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Anesthesialogy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

Date of Web Publication21-Sep-2013

Correspondence Address:
Seyed Mohammad Vahid Hosseini
Sick Hospital Children of Bandar
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2006-8808.118632

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   Abstract 

Tracheomalacia is a common disorder in neonate and infants, which can lead to life-threatening airway occlusion, because of external pressure or intrinsic defect of tracheobroncial cartilage. Aortopexy and Stents are effective in relieving tracheomalacia in the latter patients. In this case we are to show how t-tube cholangiocatheter is effective and easy available in sever tracheomalacia neonates with intrinsic defect. It can be easily replaced and causes no infection, erosion, or sever complication in 9 months period.

Keywords: Stent, tracheomalacia, t - tube cholangiocatheter


How to cite this article:
Hosseini SV, Zarenezhad M, Sabet B, Shoar MM, Kangari G. The use of t-tube cholangiocatheter stents in the treatment of pediatric tracheomalacia. J Surg Tech Case Report 2013;5:54-5

How to cite this URL:
Hosseini SV, Zarenezhad M, Sabet B, Shoar MM, Kangari G. The use of t-tube cholangiocatheter stents in the treatment of pediatric tracheomalacia. J Surg Tech Case Report [serial online] 2013 [cited 2016 May 25];5:54-5. Available from: http://www.jstcr.org/text.asp?2013/5/1/54/118632


   Introduction Top


Tracheomalacia are usually caused by anterior great vessel compression on trachea that had intrinsic defect in cartilage maturation and is a common disorder in neonate and infants, which can lead to life-threatening airway occlusion. [1] Many stents are effective in relieving lower tracheomalacia and bronchomalacia in select patients, [2],[3] however, only patients in whom conventional therapy, including 6 week of intubation, positive pressure, and steroid has failed should be considered for stent placement or Aortopexy. In this case we are to show how t-tube cholangiocatheter is effective and easy available in sever tracheomalacia patients with intrinsic defect has obviated the Aortopexy or difficult tracheostomy care in small neonate who had failed to respond to conservative therapy.


   Case Report Top


A 42-day-old baby boy who underwent mechanical ventilation in the second day of life gradually weaned off from the respirator but while extubated, he could not tolerate extubation. He had severe tracheomalacia on rigid bronchoscopy. Patient had Echocardiography and spiral computed tomography scan for ruling out of extrinsic pressure, after being certain of abnormal vasculature or mass, we decided to insert some kinds of stent which available. T-tube tracheal stent was rigid and not suitable in size and pliability for trachea of neonate. T-tube cholangiogram has the same shape but a very pliable and suitable size #16 (SUPA/Iran) with low cost for small neonate. We performed 1-2 cm incision above sternal notch and through a tracheotomy and trimming the catheter to appropriate size was placed [Figure 1]. He tolerated the tube and discharged and 9 months later tube can be discontinued.
Figure 1: T-tube cholangiogram inserted as stent in a neonate with sever tracheomalacia

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   Discussion Top


Tracheobronchial obstruction is associated with a significant morbidity and mortality. The purpose of this study is to review the results of a new available stent through tracheotomy in a neonate with tracheomalacia, and with special concern on safety and clinical effectiveness. Although placement of other stents such as covered retrievable expandable metallic stents are safe for the treatment, ventilator weaning, and dyspnea improvement has been seen in all cases after stent placement. [4] The advantages of expandable metallic stents over the other available techniques include delivering in a non-expanded state using flexible over-wire systems through a bronchoscope. The epithelializations of stents prevent migration and also ciliary activity can be continued. There are many complications during their usage that are airway inflammation, stent migration, airway erosion, stent fracture and collapse. In these patients computed tomography in assessing airway morphologic features and dynamics distal to the stent, and can be valuable. [5],[6]

We have also performed Aortopexy in some of our patients, included partial thymectomy and fixation of intra pericardial aortic arch to under surface of sternum. This method advocated in many studies as preferable choice for those who had failed responding to conventional therapy, however, it has its morbidity and complications for small neonate, bleeding, risk of thoracotomy, detachment of fixation, phrenic nerve injury despite being successful in more than of 50% of patients. [7],[8]

Despite above complication T-tube cholangiocatheter stent is ready available with no migration and can be used as same as silicone stent in patients with tracheomalacia. [7] T-tube cholangiocatheter has lower cost than other material used to for tracheomalacia in another study. [8] It can be easily replaced and causes no infection, erosion or sever complication in short period; however, larger trial need to evaluate this method perfectly.

 
   References Top

1.Weber TR, Keller MS, Fiore A. Aortic suspension (aortopexy) for severe tracheomalacia in infants and children. Am J Surg 2002;184:573-7.  Back to cited text no. 1
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2.Furman RH, Backer CL, Dunham ME, Donaldson J, Mavroudis C, Holinger LD. The use of balloon-expandable metallic stents in the treatment of pediatric tracheomalacia and bronchomalacia. Arch Otolaryngol Head Neck Surg 1999;125:203-7.  Back to cited text no. 2
    
3.Antón-Pacheco JL, Cabezalí D, Tejedor R, López M, Luna C, Comas JV, et al. The role of airway stenting in pediatric tracheobronchial obstruction. Eur J Cardiothorac Surg 2008;33:1069-75.  Back to cited text no. 3
    
4.Shin JH, Hong SJ, Song HY, Park SJ, Ko GY, Lee SY, et al. Placement of covered retrievable expandable metallic stents for pediatric tracheobronchial obstruction. J Vasc Interv Radiol 2006;17:309-17.  Back to cited text no. 4
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5.Lehman JD, Gordon RL, Kerlan RK Jr, Laberge JM, Wilson MW, Golden JA, et al. Expandable metallic stents in benign tracheobronchial obstruction. J Thorac Imaging 1998;13:105-15.  Back to cited text no. 5
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6.Vinograd I, Keidar S, Weinberg M, Silbiger A. Treatment of airway obstruction by metallic stents in infants and children. J Thorac Cardiovasc Surg 2005;130:146-50.  Back to cited text no. 6
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7.Fayon M, Donato L, de Blic J, Labbé A, Becmeur F, Mely L, et al. French experience of silicone tracheobronchial stenting in children. Pediatr Pulmonol 2005;39:21-7.  Back to cited text no. 7
    
8.Tsugawa C, Nishijima E, Muraji T, Yoshimura M, Tsubota N, Asano H. A shape memory airway stent for tracheobronchomalacia in children: An experimental and clinical study. J Pediatr Surg 1997;32:50-3.  Back to cited text no. 8
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