A 52-yr-old man undergoing laparoscopic colectomy had a significant peritubal air leak after initiation of mechanical ventilation using a 7.5-size endotracheal tube (ETT). Peritubal air leak continued even after an 8.0-size ETT with excessive cuff inflation had been used. Multiple tracheal diverticula were detected during flexible bronchoscopy, and the tube was inserted beyond the diverticula. After excessive cuff inflation, leakage was limited to a clinically acceptable value. Preoperative computed tomography revealed Mounier–Kuhn syndrome with multiple tracheal diverticula (fig. 1, A to C, red arrows).
Mounier–Kuhn syndrome is characterized by marked dilatation of the trachea and main bronchi resulting from thinning or atrophy of elastic fibers and smooth muscles. Mounier–Kuhn syndrome is diagnosed based on computed tomography findings of the transverse tracheal diameter exceeding 30 mm and right and left main bronchi diameters exceeding 24 and 23 mm, respectively1 (fig. 1, A and B)....