Delayed-onset tracheal rupture after prone-position surgery: a case report of conservative management without bronchoscopy and literature review

Tracheobronchial injury, while rare, carries a significant risk of mortality, with iatrogenic causes being predominant. This article presents a singular case of delayed tracheal rupture following percutaneous nephrolithotomy conducted under general anesthesia in the prone position. This case is particularly noteworthy for its occurrence after a routine single-lumen intubation and its successful non-operative management despite the patient's refusal of bronchoscopic intervention, challenging conventional diagnostic protocols. The underlying mechanism may involve dynamic endotracheal tube displacement exacerbated by prolonged prone positioning, leading to sustained pressure on the tracheal wall. We emphasize that early recognition based on clinical signs and computed tomography, rather than relying solely on bronchoscopy, can be a critical determinant of a positive outcome. Additionally, we provide a synthesized review of the literature, discussing the mechanisms, diagnostic modalities, and evolving conservative therapeutic strategies for this life-threatening complication, with a special focus on the underreported risks associated with dynamic tube movement in prone positioning.