Dane EDİGER, Esra UZASLAN, Mehmet KARADAĞ, Ahmet URSAVAŞ

An unusual way of tracheal stoma cleaning could end up with foreign body aspiration in a laryngectomized patient

Bu olgu sunumunda, yabancı cisim aspirasyonlarının oldukça olağan dışı bir şekli olarak, larenjektomili bir hastanın trakeal stomasından ağaç çubuğu aspirasyonunu sunmayı amaçladık. Olgumuz, ucunda zeytinyağına batırılmış pamuk olan ağaç dalını trakeostomi deliğinden geçirerek üst solunum yolu sekresyonlarını temizlemeyi alışkanlık edinmişti. Hastaya trakeostomi deliğinden aerosol lidokain verilerek yapılan lokal anesteziyi takiben fleksibl fiberoptik bronkoskopi uyguladık ve 11 cm’den daha uzun bir ağaç dalını dışarıya çıkardık. Bronkoskopiyi takiben hastanın yakınmaları düzeldi. Bu tür olgularda deneyimli bir ekip ve uygun bronkoskopi aksesuarlarının bulunması durumunda lokal anestezi altında fleksibl fiberoptik bronkoskopi uygulanmasının emniyetle yapılabileceğini gördük. Aynı zamanda bize bu olgu, kulak burun boğaz uzmanlarının ve larenjektomili hastaları takip eden diğer hekimlerin hastalarını stoma temizliği hakkında eğitmelerinin ve hata yapmaları sonucunda hayatı tehdit edici durumlar ile karşılaşabilecekleri konusunda bilgilendirmelerinin önemini gösterdi.

Larenjektomili bir hastada yabancı cisim aspirasyonu ile sonuçlanan trakeal stoma temizliği

We report a case of a laryngectomized patient who accidentally aspirated a wooden stick through his tracheal stoma in highly unusual circumstances. He was in a habit of cleaning secretions of upper airway with a wooden stick covered with cotton on the tip soaked in olive oil, via tracheostomy. After applying topical aerolized lidocaine spray through the tracheostomy stoma a flexible video-brochoscopy was performed and a tree twig over 11 cm in length was removed. The patient’s symptoms were resolved by a bronchoscopy. With experience and availability of accessories, the removal of the foreign body using flexible bronchoscope under local anesthesia can be performed safely and successfully. This case suggests that the physicians and otolaryngologists should educate their laryngectomized patients about stomal care and discuss any potential life-threatening situation they might encounter.

PDF

___

1. Friedman EM. Tracheobronchial foreign bodies. Otolaryngol Clin North Am 2000; 33: 179-85.
2. Limper AH, Prakash UBS. Tracheobronchial foreign bodies in adults. Ann Intern Med 1990; 112: 604-9.
3. Nwiloh J, Fortson J. Aspirated foreign body in a laryngectomized patient: case report and literature review. Ear Nose Throat J 2001; 80: 744-6.
4. Rehurek L. Unusual complications caused by a foreign body in the tracheobronchial tree. Laryngoscope 1975; 85: 1767-9.
5. Cannon CR. Small tracheal stoma: an unusual cause of aspiration. South Med J 1982; 75: 512-3.
6. Finkelstein DM, Noyek AM, Friedberg J, Goldberg M. Inhalation of a safety pin by a laryngectomized patient: a case report. J Otolaryngol 1989; 18: 189-92.
7. Eliashar R, Sichel JY, Dano I, Saah D. Foreign body aspiration in a laryngectomized patient. Am J Emerg Med 1998; 16: 103-4.
8. Erdozain Rodriguez I, Sanchez Galan L, Zabaleta Lopez M, Sanchez del Hoyo A. Tracheobronchial foreign body in the laryngectomized patient. An Otorrinolaringol Ibero Am 1998; 25: 185-92.
9. San I, Alatas N, Iynen I. An unusual tracheobronchial aspiration in a patient with total laryngectomy. Kulak Burun Bogaz Ihtis Derg 2002; 9: 139-41.
10. Mormile M, Balzano B, Maniscalco M, et al. Recurrent foreign body aspiration in the airways in a laryngectomized patient. Otolaryngol Head Neck Surg 2003; 129: 152-3.
11. Otto RA, Davis W. Tracheostomy tube fracture: an unusual etiology of upper respiratory airway obstruction. Laryngoscope 1985; 95: 980-1.
12. Swensson EE, Rah KH, Kim MC, et al. Extraction of large tracheal foreign bodies through a tracheostoma under bronchoscopic control. Ann Thorac Surg 1985; 39: 251-3.
13. Dogan K, Kaptanoglu M, Onen A, Saba T. Unusual sites of uncommon endobronchial foreign bodies. Reports of four cases. Scand Cardiovasc J 1999; 33: 309-11.
14. Krempl GA, Otto RA. Fracture at fenestration of synthetic tracheostomy tube resulting in a tracheobronchial airway foreign body. South Med J 1999; 92: 526-8.
15. Pawar DK. Dislodgement of bronchial foreign body during retrieval in children. Paediatr Anaesth 2000; 10: 333-5.
16. Rafanan AL, Mehta AC. Adult airway foreign body removal. What’s new? Clin Chest Med 2001; 22: 319-30.
17. Clark PT, Williams TJ, Teichtahl H, et al. Removal of proximal and peripheral endobronchial foreign bodies with the flexible fibreoptic bronchoscope. Anaesth Intensive Care 1989; 17: 205-8.
18. Cunanan OS. The flexible fiberoptic bronchoscope in foreign body removal. Experience in 300 cases. Chest 1978; 73: 725-6.
19. Hiller C, Lerner S, Varnum R, et al. Foreign body removal with the flexible fiberoptic bronchoscope. Endoscopy 1977; 9: 216-22.
20. Nunez H, Perez Rodriguez E, Alvarado C, et al. Foreign body aspirate extraction. Chest 1989; 96: 698.
21. Marlow TJ, Schabel SI, Goltra DD Jr. Endobronchial cockroach: an unusual foreign body aspiration. J Emerg Med 1997; 15: 487-9.
22. Black RE, Johnson DG, Matlak ME. Bronchoscopic removal of aspirated foreign bodies in children. J Pediatr Surg 1994; 29: 682-4.