Lung preservation in a case of complex rupture of right main bronchus and segmental bronchi injury with lung laceration.

Repairing complex bronchial injury is challenging. We present a case of successful bronchial repair with preservation of the entire lung in a complex bronchial injury. An 18-year-old male presented with pneumothorax and minimal dyspnea following blunt chest trauma and was managed with intercostal drainage and resuscitation. A review after 48 h showed a fallen lung sign with a Cerfolio 4C air leak. Computed tomography (CT) scan confirmed the right main bronchial injury. On exploration, a lacerated consolidated right upper lobe with dusky discoloration was noted. Longitudinal avulsion of 2/3rd of the anterior wall of the right main bronchus (RMB) at the level of the upper lobe bronchus, extending up to the segmental bronchi of the upper lobe, causing complete disruption of the confluence of secondary bronchi was noted along with disruption of the bronchus intermedius. Three segmental bronchi of the upper lobe were sutured together into a common confluence and reimplanted on the RMB. The anterior wall of the RMB and the bronchus intermedius were repaired and reinforced with an intercostal flap. The parenchymal laceration was repaired. Serial chest radiograph showed complete expansion of the middle and lower lobes with gradual improvement of the upper lobe. Check bronchoscopy showed a healthy repair margin with partial stenosis in the anterior and posterior segmental bronchi. Following bronchoscopy and lavage, upper lobe air entry improved with a residual wedge of consolidation of the upper lobe on discharge. Four months follow-up showed improved lung status with no symptoms. In our case, lung preservation was considered as the patient was young and did not have any features of sepsis and there was no history of primary lung disease. Lung preservation should be considered whenever feasible in complex bronchial injuries.