Abstract
Foreign bodies in the airway, as well as those in the upper gastrointestinal tract, are life-threatening conditions and require prompt intervention. We report on a 44-year-old male patient who presented with 4 days of intermittent cough. A computed tomography was performed showing two metallic foreign bodies located in the right main bronchus and the duodenum. The knife blade was successfully removed by upper gastrointestinal endoscopy. However, the broken end of the blade was incarcerated in the right main bronchus and was removed via thoracotomy after the failure of endoscopic treatment. Endoscopy, such as flexible/rigid bronchoscopy or gastroscopy, is the first choice for removing foreign bodies for its minimal invasiveness. Nevertheless, removal of foreign bodies might be technically difficult when incarcerated, and surgical treatment is indicated after unsuccessful endoscopic treatment.
Keywords: Foreign bodies, Surgery, Trachea, Upper gastrointestinal tract
A 44-year-old male patient presented with 4 days of intermittent cough. He had a 30-year history of alcohol abuse, and a 10-cm broken fruit knife was swallowed to attempt suicide after taking alcohol 4 days before. He denied any other complaints. The patient’s vital signs were stable. On examination, the breath sounds on the right chest were slightly decreased. A computed tomography was performed showing two metallic foreign bodies measuring 7.8 × 1.2 cm (Fig. 1a, c) and 3.6 × 1.2 cm (Fig. 1b, c) located in the right main bronchus and the duodenum. A subsequent upper gastrointestinal endoscopy was performed, and the knife blade was found in the descending part of the duodenum and was successfully removed by endoscopy (Fig. 1d). However, the broken end of the blade was incarcerated in the right main bronchus and was removed via thoracotomy after the failure of endoscopic treatment (Fig. 1d). The patient’s postoperative course was uneventful, and discharged on postoperative day seven.
Fig. 1.
a Metallic foreign body in the right main bronchus (RMB) revealed by chest computerized tomography (CT) (white arrowhead). b Metallic foreign body in the descending part of the duodenum in the right upper quadrant (RUQ) revealed by chest CT (white arrow). c Metallic foreign bodies in the RMB (white arrowhead) and RUQ (white arrow) as revealed by three-dimensional reconstruction. d Two parts of broken fruit knife after operation
Discussion
Foreign bodies in the airway, as well as those in the upper gastrointestinal tract, are life-threatening conditions and require prompt intervention. Tracheobronchial foreign bodies occur predominantly among infants and young children [1] and are rare in adults. In this interesting case, the patient’s swallowing and cough reflexes were compromised after alcohol abuse, which might have resulted in the coexistence of foreign bodies both in the airway and digestive tracts. Occasionally, the foreign body could transfer from the respiratory tract to the gastrointestinal tract [2]. Endoscopy, such as flexible/rigid bronchoscopy or gastroscopy, is the first choice for removing foreign bodies for its minimal invasiveness. However, removal of foreign bodies might be technically difficult when incarcerated, and surgical treatment is indicated after unsuccessful endoscopic treatment.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Footnotes
Co-first authors Chenglin Guo and Yong Yuan contributed equally to this paper.
References
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