Traumatic Rupture of the Bronchus

TRAUMATIC rupture of the bronchus is an uncommon occurrence. Its importance lies in the fact that it is a condition dangerous to life, which, if recognized, is frequently remediable by operation. Rarely survival ensues without treatment. The accident is most frequently found as a sequel of a street accident in which a wheel passes over the thorax, possibly, but not necessarily, fracturing several ribs. The condition may also result from other indirect injuries. (Dark and Jewsbury, 1955; Meade and Graham, 1930.) Kinsella and Johnsrud (1947), in their exhaustive review of the literature, credit Seuvre (1873) with the first description of the condition. Shield (1889) first described the occurrence of bronchial rupture in Great Britain. Krinitzki (1928) recorded the first case of survival without treatment. Surgical interference has greatly improved the prognosis for these patients. Some cases have been treated by early or immediate lobectomy (Dark and Jewsbury, 1955) where a primary bronchus was involved, and by pneumonectomy (Kirkpatrick, 1950) for involvement of the main bronchus. Other cases have had early repair of the bronchus (Scannell, 1951) or resection of the affected portion of the bronchus (Griffith, 1949), with repair. If the diagnosis has been made later, in patients who have survived the immediate effects of the injury, late plastic repair, as practised by Paulson (1951), and Weisel and Jake (1953), has produced good results. Pneumonectomy has been performed as long as ten years after the original injury, where a consequent bronchial stricture was complicated by saccular bronchiectasis. (Paulson, 1951; Dalgleish, et al., 1934.) The condlition has been reviewed by Krauss (1956), who added four further cases to the literature. This case illustrates the classical features of the condition together with the usual development of complications which, in this instance, proved fatal.