Acute pharyngeal obstruction from a glass methamphetamine pipe: A case report

Acute airway foreign bodies are an uncommon but life-threatening pathology encountered in the emergency department. We present the case of a 41 year old female who presented for acute obstruction of the posterior pharynx following attempted ingestion of a glass methamphetamine pipe in efforts to conceal evidence from law enforcement officers. She exhibited mild trismus and muffled voice. No respiratory distress, stridor or hypoxia was appreciated. Workup revealed a vertically oriented cylindrical glass foreign body, approximately 10 cm spanning the distance between the proximal esophagus and posterior nasopharynx. Treatment was initiated with low-dose benzodiazepine therapy for anxiolysis, administered nebulized lidocaine while preparations were made for emergency cricothyroidotomy and rapid sequence intubation with fiberoptic support. Otolaryngology was emergently consulted and ultimately the decision was made to attempt removal, with a plan for emergent surgical airway placement if unsuccessful. The patient was positioned with the neck hyperextended and ketamine was given for sedation. Using a pair of rubberized Magill forceps that we created, the glass pipe was successfully removed. The patient returned to her pre-procedural baseline and was discharged. Patients with acute airway obstruction can rapidly decline and otolaryngology support is often not readily available. In this report we will discuss the considerations in managing acute airway foreign bodies, maneuvers and specialized tools to assist with bedside removal.