• Weiwei Zhou, Yantao Lang, Zhongling Xu, and Dekun Yin.
• Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
• Medicine (Baltimore). 2023 Aug 11; 102 (32): e34536e34536.

RationaleTracheal diverticulum is a rare airway-related particular occurrence, and the forcible tube insertion may cause tracheal ruptures during tracheotomy. Therefore, fiberoptic bronchoscopy (FOB) should be used routinely on all patients undergoing tracheal intubation or tracheotomy.Patient ConcernsA 60-year-old male with laryngeal neoplasms was scheduled for partial laryngectomy using a suspension laryngoscope in July 2020. All operations were performed under general anesthesia through orotracheal intubation. Orotracheal intubation was a noninvasive procedure that could effectively control breathing. At the end of the surgery, the percutaneous tracheostomy was performed to maintain airway patency, facilitate spontaneous respiration, and remove the secretions.DiagnosesAt this moment, the tracheal diverticulum, located at the right posterolateral region of the trachea, became an unexpected airway-related particular occurrence, which led to tracheal tube placement difficulty, mechanical ventilation difficulty, and high airway pressure.InterventionsSubsequently, the tracheal tube was repositioned, with placement again confirmed by the FOB.Lessons SubsectionsTracheal diverticulum is an infrequent cause of tube inserting difficulty for the tracheotomy, and FOB is the first option for patients with catheter placement difficulty and mechanical ventilation difficulty.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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