Author(s)
Melissa Zheng, Tanya Meyer
Affiliation(s)
University of Washington;
Abstract:
Objective: To demonstrate a unique airway foreign body retrieved through a tracheal t-tube.
Method: Case report and video presentation.
Results: A 66-year-old woman who is t-tube dependent secondary to tracheal stenosis was cleaning her t-tube at home with a cotton swab when it broke off and fell into her airway. Upon presentation to the hospital, CT chest and tracheobronchoscopy revealed that it was lodged in her left mainstem bronchus. She was evaluated in the otolaryngology clinic where removal was attempted using working channel forceps through a flexible bronchoscope. Attempts made both through the horizontal t-tube limb and through the nose were unsuccessful due to the large size of the swab, the angle of the t-tube limb, and small caliber of the 11mm t-tube. The patient was thus taken to the operating room. After induction of general anesthesia, a 4-0 endotracheal tube was inserted into the t-tube. The larynx was exposed with a Dedo laryngoscope and placed into suspension, and the endotracheal tube was removed. A 0-degree telescope placed through the laryngoscope and upper t-tube limb was used for visualization, and a laryngeal cup forceps inserted through the horizontal limb of the t-tube was used to successfully retrieve the foreign body. The removed cotton swab measured 6cm in length. The patient emerged from anesthesia without complications and was discharged home.
Conclusions: This case represents a foreign body retrieval through a relatively rare airway device necessitating an innovative approach in the operating room.