[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-453861-105":3,"detail-sidebar-cat-0-en-105":73,"doc-detail-453861-en":122},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":66,"head_meta":68,"extra_data":70,"updated_unix":72},105,"en","subcutaneous-emphysema-following-tracheocutaneous-fistula-closure-in-a-pediatric-patient-a-case-report","Subcutaneous Emphysema Following Tracheocutaneous Fistula Closure in a Pediatric Patient: A Case Report","","Tracheocutaneous fistula (TCF) can occur after tracheostomy decannulation, and while closure is usually safe, rare complications may become life-threatening. This case report describes a four-year-old boy with prematurity, cleft palate, cleft lip, and ectopic kidney who developed persistent TCF after neonatal tracheostomy for aspiration pneumonia. Primary surgical repair was performed under general anesthesia, and ten hours postoperatively diffuse subcutaneous emphysema with respiratory distress required wound reopening, intubation, drainage, and re-suturing. Imaging showed extensive emphysema with a small pneumothorax, and supportive care with ventilation, nutrition, fluids, and antibiotics led to gradual resolution and discharge after six days, emphasizing vigilant pediatric perioperative planning and early recognition.",{"@graph":14,"@context":65},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/subcutaneous-emphysema-following-tracheocutaneous-fistula-closure-in-a-pediatric-patient-a-case-report/453861/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/subcutaneous-emphysema-following-tracheocutaneous-fistula-closure-in-a-pediatric-patient-a-case-report/453861.png","ImageObject",300,407,{"name":42,"@type":43},"Ophelia","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59],{"name":60,"@type":61,"acceptedAnswer":62},"How was the patient managed after emergency intervention, and what was the outcome?","Question",{"text":63,"@type":64},"Supportive care included mechanical ventilation, nasogastric feeding, intravenous fluids, and antibiotics. Imaging confirmed extensive emphysema with a small pneumothorax, and the patient gradually improved and was discharged in stable condition after six days with continued follow-up.","Answer","https://schema.org",{"og:url":32,"og:type":67,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":69,"canonical":32},"index,follow",{"doc_id":71,"site_id":7},453861,1790791573,{"code":4,"msg":74,"data":75},"success",[76,80,84,88,93,98,102,106,111,114,118],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":77,"show_sort_weight":78,"slug":79},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":81,"show_sort_weight":82,"slug":83},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Exam",70,"exam",{"id":89,"doc_module":4,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},5,"Comic",60,"comic",{"id":94,"doc_module":4,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},6,"Technology",50,"technology",{"id":99,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":100,"slug":101},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},"Research & Report",30,"research-report",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":108,"show_sort_weight":109,"slug":110},9,"Religion & Spirituality",20,"religion-spirituality",{"id":109,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":109,"slug":113},"World Cup","world-cup",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":115,"slug":117},10,"Lifestyle","lifestyle",{"id":119,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":89,"slug":121},19,"General","general",{"code":4,"msg":74,"data":123},{"doc_id":71,"user_id":124,"nickname":42,"user_avatar":125,"doc_module":4,"category_id":99,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":126,"file_id":127,"file_url":128,"file_type":129,"file_size":130,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":94,"language":131,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":132,"faqs":133,"seo_title":134,"seo_description":12,"update_tm":135,"read_time":136,"preview_page_count":4},7971461741311,"https://ap-avatar.wpscdn.com/avatar/74000253aff267980c6?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779345379180704826","Review began 12/14/2025  \nReview ended 12/21/2025  \nPublished 01/07/2026  \n© Copyright 2026  \nAlZayani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.100974  \nOpen Access Case Report  \nSubcutaneous Emphysema Following Tracheocutaneous Fistula Closure in a Pediatric Patient: A Case Report  \nAbdulRahman R. AlZayani 1, Rashed Aldoseri 2 , Mohamed Alshehabi 2, Mai Nasser 1  \n1. Otolaryngology-Head and Neck Surgery, Royal Medical Services-Bahrain Defence Force Hospital, Riffa, BHR 2. Ear, Nose, and Throat (ENT), Royal Medical Services-Bahrain Defence Force Hospital, Riffa, BHR  \nCorresponding author: AbdulRahman R. AlZayani, [zayani@live.com](zayani@live.com)  \nAbstract  \nTracheocutaneous fistula (TCF) is a known complication following tracheostomy decannulation. While closure is generally safe, rare but potentially life-threatening complications such as subcutaneous emphysema may occur. We report the case of a four-year-old boy with a history of prematurity, cleft palate, cleft lip, and ectopic kidney, who developed persistent TCF after tracheostomy performed for aspiration pneumonia at two months of age. Following decannulation and subsequent scheduling for elective closure, the patient underwent primary surgical repair under general anesthesia. Ten hours postoperatively, he developed diffuse subcutaneous emphysema with respiratory distress. Emergency intervention included reopening of the wound, intubation, drain placement, and re-suturing, followed by intensive care monitoring. Imaging confirmed extensive subcutaneous emphysema and a small pneumothorax. Supportive management with mechanical ventilation, nasogastric feeding, intravenous fluids, and antibiotics led to gradual resolution. He was discharged in stable condition after six days and has remained well on follow-up. Postoperative ventilation was essential to maintain airway stability despite the potential risk of propagation. There is a need for individualized perioperative planning and vigilant monitoring in pediatric patients. TCF closure is generally safe, but clinicians should remain alert to potential airway complications such as subcutaneous emphysema. Early recognition and prompt management are critical for favorable outcomes. This case emphasizes the importance of careful perioperative decision-making, especially in children with multiple comorbidities.  \nCategories: Pediatrics, Otolaryngology  \nKeywords: pediatric airway emergency, post op subcutaneous emphysema, subcutaneous emphysema management, tracheocutaneous fistula, tracheostomy complications  \nIntroduction  \nTracheocutaneous fistula (TCF) is an abnormal communication between the trachea and the skin. It occurs as a complication of tracheostomy tube decannulation, with incidence rates varying across published studies. Historically, persistent TCF incidence was reported between 1-3%[1,2] . But more recent studies have reported incidence up to 65%[3] . It usually persists in patients who are tracheostomized for more thana year [4,5] .  \nThe closure of TCFs carries inherent risks, one of which is subcutaneous emphysema, a rare but serious complication that may require urgent surgical intervention [6] . Subcutaneous emphysema occurs when air escapes from the trachea into the subcutaneous tissue, with multiple factors contributing to the occurrence of this complication. In the context of TCF repair, it is usually due to incomplete closure of the trachea or disruption of the surgical repair, leading to air leakage into the surrounding soft tissues. Although rare and infrequently reported as a standalone complication, it is typically included within the broader rates of complications associated with TCF repair.  \nMultiple techniques have been described for TCF closure, most notably pr","cbCaiuZ54oOuo7Rz","https://ap.wps.com/l/cbCaiuZ54oOuo7Rz","pdf",3280600,"English","# Introduction\n# Case Presentation\n## Patient background\n## Surgical repair and postoperative course\n## Emergency intervention and follow-up","[{\"question\":\"How was the patient managed after emergency intervention, and what was the outcome?\",\"answer\":\"Supportive care included mechanical ventilation, nasogastric feeding, intravenous fluids, and antibiotics. Imaging confirmed extensive emphysema with a small pneumothorax, and the patient gradually improved and was discharged in stable condition after six days with continued follow-up.\"}]","Subcutaneous Emphysema Following Tracheocutaneous Fistula Closure in a Pediatric Patient: A Case Report | PDF",1790739742,15]