A Tracheo-innominate Artery Fistula after Tracheostomy

A case of a late fatal hemorrhage following tracheostomy was reported. A 45-year-old male underwent thymoma resection and then radiation therapy 9 yaers ago. Even though he underwent a thymoma resection, he showed dyspnea caused by myasthenia gravis 9 years after the operation. Because of the dyspnea, a tracheostomy was performed and a steroid was administered for the treatment of his myasthenia gravis. Three months after the tracheostomy, a massive hemorrhage occurred through the tracheostoma because of a tracheo-innominate artery fistula. The fistula was immediately closed using a tracheal tube with an air cuff and thus successfully controlled. Then, an emergency operation was performed under general anesthesia. A fistula was observed in a tracheal wall and in an innominate artery wall. These fistulae were sutured and a patch of the fascia was inserted between them. Bleeding occurred again from the tracheostoma 2 months after the operation and resulted in the patient's death.