48 year old Joel Portillo Mapilis consulted Dr. Khaldoon Abo Dakka Specialist Thoracic Surgery at Zulekha Hospital Dubai with asthma symptoms he was experiencing since last three years including wheezing, shortness of breath, and cough which had begun during COVID times in 2020. He is a non-smoker and had not experienced any type of allergies earlier. He was under typical asthma treatment with inhalers and nebulization without much relief from his symptoms. Nine months before his surgery, he started worsening and had blood-stained sputum on coughing (hemoptysis), a husky sound, and progressive difficulty of breathing.
Dr. Khaldoon explained, “A CT chest scan revealed a 3*2 CM cylindrical-shaped tumor in the mid of his trachea at the level of his chest-inlet behind the upper part of breast bone. A pulmonologist in another facility had done a bronchoscopy to find a large slow-growing rare primary malignant tumor of trachea, invading the wall of his windpipe and blocking the main airway lumen by 80%. Biopsies confirmed a very rare malignant tumor arose in the sub-mucosal glands of mid-Trachea called ‘Adenoid Cystic Carcinoma’”.
The disease seemed to have developed over few years to cause a mechanical airway obstruction and produce fake symptoms like that of an asthma disease. While there is no specific cause, doctors warn individuals not to ignore any minor complaints such as cough or blood-stained sputum, as small issues become major if not diagnosed and treated on time.
Dr. Khaldoon says, “Healthcare workers must note this. Absence of allergy or smoking history for patient with uncontrolled new symptoms of asthma does urge us to do further investigations and even invasive procedures as endoscopy to rule out rare unexpected airway diseases.”
“Tracheal neoplasms occur infrequently at a rate of two new cases per million people per year, accounting for less than 1% of all malignancies. In this case, early diagnosis was the most important factor affecting overall survival and the complete surgical resection was the only hope as curative treatment, even with a high peri-operative mortality rate up to ten percent.”
At Zulekha Hospital Dubai the team of surgeons including Thoracic Onco-surgeon Dr Khaldoon Abo Dakka, Dr Sameh Aboamer Consultant Surgical Oncology, and Specialist Anesthetist Dr Sarwesh Kumar performed the surgery for about six hours to remove the airway obstruction and re-establish the airway continuity. The procedures included a Segmental Resection of the mid-third of Trachea involved by the tracheal tumor (total are eight tracheal rings = 4 cms length, which accounts for nearly 40% of the whole trachea), and Tracheal Reconstruction was done by end-to-end anastomosis (Tracheoplasty)” Trans Collar Neck Incision.
Speaking of the high risks during the surgery, Dr Sarwesh stated, “Making sure the patient’s airway and ventilation was secure through the procedure, we could only use a narrow lumen tube through the trachea to intubate the patient under guidance of a flexible bronchoscope as the large tumor blocked majority of the airway. In addition, special care was taken at the end of procedure to ensure safe extubation (removal) of anesthesia tube, so we could avoid perilous re-intubation”
Dr Khaldoon illustrated, “Further the deep position of the tumor in the mid segment of trachea into the Thoracic Inlet (inside the entrance of chest-cavity), had to be taken care during tracheoplasty to avoid sewing of his patient’s breast bone. Any damage to key vital structures close to the back wall of trachea, like food-pipe and sounding nerves, was avoided to ensure there were no post-operative complications. We took extreme care to preserve enough length of trachea to avoid any tension on the suturing line of the adjoining connections.”
Dr Sameh added, “A complete dissection of the central lymph nodes of neck surrounding the trachea was accomplished to confirm the tumor has not spread to regional lymph nodes. Bronchoscopy was being done through the procedure to highlight the excision edges and to ensure lungs and airway passages were clear. The patient had to avoid head hyper-extension so his chin was fixed to chest for seven days until complete healing of trachea.”
Experiencing his satisfaction, Joel thanks the team of doctors for the right diagnosis and treatment done and said, “I have not been breathing completely for a long time and now I feel my breath is clear and there is no obstruction in my throat and no change in my voice tone”. His total hospital stay was for eight days. Joel has been advised to follow up regularly over the next five to ten years with CT scans and bronchoscopies. Joel maintained a soft diet for some time and regained his normal diet.
Known for its multidisciplinary approach to patient treatments, Zulekha Hospital has always been at the forefront of accepting and successfully treating high-risk diseases. The presence of experienced multidisciplinary experts enables the most complex procedures to be done in the interest of the patient’s wellbeing at their facilities.
About Zulekha Healthcare Group: www.zulekhahospitals.com
Zulekha Healthcare Group is a Superbrand among the forerunners in UAE healthcare. Today the Group includes two multidisciplinary hospitals in Dubai and Sharjah, as well as UAE medical centers and pharmacies providing specialized services and treatments in over 30 disciplines. The Group has a multidisciplinary Hospital in India - Alexis. Zulekha Hospital has received extensive recognition for its commitment towards quality care and sustainable business practices, and received the prestigious Dubai Quality Award as well, underling a commitment to providing high quality healthcare to patients and society.
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