Management of massive subcutaneous emphysema with a surgical tracheostomy

Introduction: Interventions for massive subcutaneous emphysema is rarely reported in the literature with lack of comparative studies and strong preferences over one treatment option compared to another. Tracheostomy is a conservative measure as compared to primary closure of tracheobronchial injury for the management of massive subcutaneous emphysema. Case report: A 62-year gentleman who developed massive subcutaneous emphysema on the 12th post-operative day following two laparoscopic abdominal surgeries and an exploratory laparotomy. A computer tomographic scan was performed showing a suspicious tenting of the trachea at right posterolateral wall at the level of T2 vertebra with locules of air seen anterolaterally to the trachea. A subsequent microlaryngobronchoscopy performed showed no defect in the subglottic region, nor tracheobronchial tree. He was successfully managed with a surgical tracheostomy whereby the emphysema showed dramatic resolution on the second postoperative day. Conclusion: Surgical tracheostomy demonstrated a success in managing massive subcutaneous emphysema.