Spontaneous angina bullosa haemorrhagica causing laryngospasm and requiring emergency intubation intraoperatively

Angina bullosa haemorrhagica (ABH) is a rare condition in which blood-filled blisters may rapidly form within the oral mucosa. While these blisters often self-resolve without treatment, there have been cases where they have caused airway compromise. We report a case involving a woman in her 70s with known ABH who developed spontaneous bullae which ruptured into the oral cavity during an elective hip replacement. After the bullae ruptured and caused laryngospasm, an emergency tracheal intubation was performed to protect the airway. We note a gap in the literature regarding this patient cohort within the perioperative setting. Given this cohort is at risk of rapidly developing spontaneous bullae, which can predispose to airway emergencies, careful assessment and consideration of elective tracheal intubation may minimise such risk. Additionally, a period of observation in a high dependency unit postoperatively may be advisable.