Delayed tracheal perforation post total thyroidectomy

Delayed tracheal perforation is a rare occurrence post thyroidectomy. We present a 72 year-old female patient that underwent elective total thyroidectomy and right upper parathyroidectomy, with bilateral central lymph node dissection and modified radical neck dissection. The post-operative period was complicated by high-risk pre-morbid status and multiple failed extubations, in addition to ischaemic tracheal areas visualised on the bronchoscopy on post-operative day (POD) 8, with subsequent computerised tomography (CT) scan showing anterior neck collections and perforation. A tracheal perforation involving the anterolateral wall (2nd and 3rd rings) was repaired surgically, followed by a tracheostomy. Suspicion of tracheal injuries should always be considered if patient fail to liberate from the mechanical ventilation post-operatively, warranting prompt conservative and/or surgical management. Potential devascularisation, secondary to diathermy-induced injury and pressure exerted by endotracheal tube cuff onto already weakened/friable trachea, should be considered as probable aetiological factors.