Missing piece: tracheobronchial foreign body aspiration during an elective thyroidectomy

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Medical Device Safety

Background:

• Airway management in thyroid surgery presents challenges, especially with anatomical variations affecting laryngoscopy.
• Bougies are essential tools for difficult intubations but carry a risk of rare fracture and subsequent tracheobronchial aspiration.

Purpose of the Study:

• To report a rare case of bougie fragment aspiration during thyroidectomy.
• To emphasize the importance of recognizing and managing this complication.

Main Methods:

• A case report of a patient undergoing thyroidectomy with difficult intubation requiring bougie use.
• Postoperative identification of a retained bougie fragment via Chest CT.
• Successful retrieval of the fragment using flexible bronchoscopy.

Main Results:

• A 2.5 cm bougie fragment was found lodged in the right lower lobe bronchus.
• Flexible bronchoscopy successfully removed the fragment.
• The patient recovered without further respiratory complications, apart from expected hypocalcemia.

Conclusions:

• Bougie fracture is an extremely rare but serious complication during intubation, particularly in challenging airway scenarios.
• Prompt diagnosis with imaging and intervention with bronchoscopy are critical for successful management.
• Preventative measures include routine device inspection and meticulous procedural planning.