Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy

Area of Science:

• Pediatric Gastroenterology
• Airway Management
• Foreign Body Removal

Background:

• Trichobezoars, or hairballs, are rare gastric foreign bodies, often associated with trichotillomania and trichophagia.
• Airway compromise during endoscopic procedures for bezoar removal is an unusual but critical complication.

Purpose of the Study:

• To report a case of airway compromise in a pediatric patient during trichobezoar removal.
• To provide management recommendations for airway obstruction caused by a foreign body.
• To highlight the importance of meticulous airway management during endoscopic foreign body extraction.

Main Methods:

• Case report detailing the endoscopic retrieval of a large gastric trichobezoar in a 5-year-old female.
• Description of the complication involving accidental endotracheal tube dislodgement and airway obstruction.
• Multidisciplinary approach involving gastroenterology and otolaryngology for successful foreign body extraction and airway management.

Main Results:

• A large trichobezoar dislodged the endotracheal tube during attempted endoscopic removal, causing partial airway obstruction.
• Initial attempts at reintubation were unsuccessful, requiring mask ventilation and specialized otolaryngology consultation.
• The trichobezoar was successfully removed using Magill forceps after endoscopic snare entrapment, followed by reintubation and airway evaluation.

Conclusions:

• Trichobezoars can present as uncommon causes of airway foreign bodies.
• Accidental extubation and airway obstruction are potential risks during endoscopic bezoar removal.
• Vigilant airway monitoring and management are essential to prevent and address complications during foreign body extraction.