Tracheal pouch developed in a child with SMA type 1 after prolonged
ventilation via tracheostomy tube due to chronic respiratory failure.
Background: 5-year-old male child, known case of SMA-1 with
chronic respiratory failure. He was ventilated since the first year of
life. Tracheostomy tube was used to manage his chronic ventilation.
Patient was admitted to long-term care center for management of his
co-morbidities. He had several attacks of desaturation since the age of
3 years, few of them progressed to cardiac arrest. During these attacks,
decreased air-entry and airway resistant was observed. A change of
tracheostomy tube led to marked improvement. Method: The case
was studied to find out the reason behind these recurrent events.
Patient was referred to ENT consultant for further assessment and
investigations. Chest x-ray & bronchoscopy were done. Surprisingly,
tracheal pouch was found in the chest x-ray which was the cause of tube
obstruction. Results: The tube obstruction was due to slipping
of its tip to the tracheal pouch which resulted in air-way obstruction,
suffocation & eventually cardiac arrest. The change of tube during the
event solved the problem temporary but whenever tube tip displaced to
the pouch the event has recurred. To prevent the recurrent obstruction,
the tube has been routinely changed by ENT specialist under direct
visualization using tracheo-bronchoscopy to ensure bypassing the
tracheal pouch and right placement of the tracheostomy tube tip.
Conclusions: Tracheal tube pouch is rare anatomical abnormality
in the trachea which associated with multiple risk factors. It can cause
air-way obstruction in ventilated patient. X-ray & tracheobroncoscope
are important in confirming the diagnosis. Bypassing the pouch during
tube insertion solves the problem.