Tracheal fistula after total thyroidectomy. Can it happen 30 days after surgery?

The patient is a 28-year-old female treated surgically for Graves-Basedow disease with total thyroidectomy. One month later, she presented swelling and tightness at the level of the surgical wound. The urgent CT scan showed cervical subcutaneous emphysema and possible tracheal fistula (Fig. 1).

Fig. 1

We decided to initiate conservative management with IV antibiotics. On the 5th day of hospitalization, the patient’s status worsened. We re-operated but found no tracheal necrosis. A millimetric tracheal defect was identified and repaired with suture and a muscle flap. The patient’s subsequent evolution was good.

Tracheal fistula after thyroidectomy is a rare complication (0.06%). Treatment varies according to the clinical situation of the patient (conservative vs. reoperation).