C44-12 Successful Open Tracheal Resection and Primary Anastomosis for Recurrent Post-Intubation Tracheal Stenosis in a Young Woman

Abstract Introduction Post-intubation tracheal stenosis is a rare but potentially life-threatening cause of upper airway obstruction. Although endoscopic balloon dilation provides temporary relief, recurrence is common when circumferential scarring or cartilaginous injury is present. Definitive management with open tracheal resection and primary anastomosis offers the best long-term outcome. We present a case of severe recurrent tracheal stenosis in a 28-year-old incarcerated female successfully managed with open tracheal resection after multiple failed endoscopic interventions. Case Presentation A 28-year-old woman with prolonged intubation for drug overdose in April 2025 presented with progressive dyspnea and inspiratory stridor. She had previously undergone balloon dilation in May 2025 with transient improvement. On readmission in June 2025, flexible laryngoscopy revealed 80-85% stenosis over a 2-cm cervical tracheal segment. Autoimmune workup was negative, reducing concern for granulomatosis with polyangiitis or other inflammatory etiologies. Intraoperatively, severe circumferential narrowing prevented passage of a 5.0 ETT; only a 3.8-mm bronchoscope could be advanced. Balloon dilation to 12 mm allowed intubation with a 5.0 ETT. Dense scarring and cartilage deformation were noted. A 2-cm stenotic segment was excised, and primary end-to-end reanastomosis was achieved with tension-free closure. Estimated blood loss was 10 mL with no complications. Postoperatively, she remained intubated and was successfully extubated under bronchoscopic guidance on postoperative day (POD) 3 with a strong voice and patent airway. Flexible laryngoscopy showed left true vocal fold hypomobility treated with corticosteroids. She healed without dehiscence, weaned to room air, tolerated a regular diet, and was discharged home on POD 10. Discussion Endoscopic dilation may provide temporary improvement in post-intubation tracheal stenosis; however, recurrence rates are high (60-70%) with circumferential fibrosis or cartilage deformation.¹ In contrast, open tracheal resection with primary anastomosis is the gold standard, with long-term airway patency 90% and recurrence 15% when tension-free anastomosis is achieved.²,³ Predictors of recurrence include diabetes, extensive scarring, prolonged intubation, and inadequate anastomotic support.² In this patient, cartilage distortion and dense fibrosis indicated limited durability of endoscopic therapy and supported timely surgical intervention. Her recovery highlights the effectiveness of multidisciplinary airway management and precise reconstructive technique in restoring durable airway patency. This abstract is funded by: none