Stomal Bleeding in a Laryngectomized Patient as a Consequence of an Infected Innominate Artery Stent: A Case Report.

backgroundLaryngectomized patients can present with stomal bleeding for a variety of etiologies that all warrant urgent evaluation and management.

methodsHere, we report a case of a patient who presented with large volume stomal bleeding at least three decades following her total laryngectomy for a dysfunctional larynx secondary to adjuvant radiation therapy she received for thyroid cancer. Her radiation therapy was also complicated by severe stenosis of her innominate-carotid artery system requiring multiple vascular interventions ultimately leading to calcified and infected arterial stents. On presentation, a tracheoscopy demonstrated an ulcerated area in the anterior tracheal wall. During the diagnostic workup for this patient, it became apparent that there was no blood flow through the distal portion of her innominate artery and that a trachea-innominate fistula, although high on the differential, was not the source of her stomal bleeding. Her clinical presentation was also complicated by bacteremia of unknown etiology.

resultsThe patient ultimately underwent surgical exploration to remove the diseased portion of her tracheostoma and an infected innominate arterial stent abutting the tracheal wall. Stomal reconstruction then took place with no further bleeding episodes postoperatively. Pathologic evaluation of the resected fibrotic tissue demonstrated bacterial species and evidence of chronic inflammation.

conclusionStomal bleeding in a laryngectomized patient should be evaluated promptly as consequences could be fatal. Although evaluation for major vessel compromise is paramount, other etiologies warrant consideration. Compromised stents of adjacent vasculature should be considered as a potential etiology in the diagnostic evaluation and management of stomal bleeding.