Sudden suffocation by surgical sponge retained after a 23-year-old thoracic surgery

A 70-year-old male patient with a 23-year-old history of right lower lung lobectomy for primary pulmonary adenocarcinoma (T1 N0 M0) presented with recurrent bronchopneumonia and purulent sputum. Pleural callus, lung abscess, bronchopleural fistula, and stitch granulomas were confirmed by chest x-ray, computed tomography scan, and bronchoscopy in the background of his complaints. An attempt to remove the bronchial purulent discharge and tissue sampling was made by using a flexible bronchoscope. The area of the lower trachea suddenly became clogged during bronchoscopic removal of the suspected piece of tissue (which later turned out to be organizing surgical gauze). The resuscitation following ventricular fibrillation failed to save the patient's life. The forensic postmortem examination confirmed the position of the foreign body extending from the abscess cavity, crossing the midline at carina and obstructing the lower trachea. This foreign body was a remnant of the surgical gauze left behind during a thoracic surgery 23 years ago.