Treatment of stent-related fulminating granulation tissue via emergency tracheostomy under topical anesthesia

Summary Technique Uncovered metallic stents have the potential to cause granulation tissue ingrowth, leading to re-occlusion and difficult or impossible retrievability. This can cause severe dyspnea or even life threatening respiratory distress. Critical tracheal stenosis which manifests itself into stridor and wheezing, while also exhibiting aggravated symptoms of orthopnea, will indicate that there is near total airway obstruction. Here, we present an awaked tracheostomy aid to initially treat the patient while under spontaneous ventilation to secure the airway readily. Results A 45-year-old female with tracheal stenosis due to tracheal trauma, underwent a tracheostomy followed by T-tube treatment. A recurrence of tracheal stenosis was noted two years later after decannulation, so the patient was employed an uncovered ultraflex stent for cosmetic reasons. Severe stenosis with orthopnea, due to fulminating granulomatosis with a variously cobble-stone shaped adherence over the proximal stent, was detected six months later. An awaked tracheostomy performed under local anesthesia following a laser ablation and removal of the stent while under general anesthesia, before an adequated T-tube stent was alternatively inserted. Conclusions The patient had maintained a hallmark of breathing ability and sound sleep after the operation, which was observed during a one-year follow-up examination.