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Tracheal pouch developed in a child with SMA type 1 after prolonged ventilation via tracheostomy tube due to chronic respiratory failure.
  • Ahmed Ibraheem,
  • Ahmad Al Khayer
Ahmed Ibraheem
NMC Healthcare Ltd

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Ahmad Al Khayer
NMC Healthcare Ltd
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Abstract

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.