[症例] プラスチック製スマートフォンケースによる小児気管異物の1例

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[要旨] 症例は10か月男児。自宅で父親のスマートフォンをくわえていて，取り上げられた直後から嗄声，喘鳴，陥没呼吸が出現した。来院時多呼吸，努力呼吸を認め，呼吸音は両側減弱し狭窄音を聴取した。両親への問診では異物吸引を疑われる状況はないとのことであった。胸部および頸部単純X線で声門下部に気管透亮像の左右差を認め，肺野，縦隔に異常はなかった。頸部CT で同部位に長さ10㎜，厚さ1㎜の膜様構造物を認め，気管異物疑いで高次搬送した。転院直後努力呼吸は消失し呼吸音も改善を認めていた。同日全身麻酔下に気管異物摘出術を施行した。全身麻酔導入後，バッグマスクおよび声門上器具による換気が困難となり，循環不全を来しRapid Response Systemを発動，数分間の胸骨圧迫を要した。異物が気道を完全閉塞する形で声門部に嵌頓しており，気管支鏡で一旦異物の片側を押し込むことで僅かな隙間ができ換気可能となり，状態は安定化した。摘出異物は父親のスマートフォンのプラスチック製ケースの破片であった。入院4 病日に抜管，入院中に院内家族支援チームの介入を行い，12病日に臨床的後遺症なく退院となった。小児気道異物は本症例のように生命に関わる緊急疾患であり，早期診断治療と何よりも予防が重要であるが，依然として毎年一定数の死亡者が存在しており，医療者，保護者への継続的な啓発が必要である。

[SUMMARY] The patient was a 10-month-old boy. He put his father’s smartphone in his mouth, and immediately after it was taken away, hoarseness, wheezing, and retractive breathing developed. On admission, the patient presented with tachypnea and labored breathing. Respiratory sounds were bilaterally weak, and expiratory stridor was noted. A medical interview to the parents revealed no suspicion that foreign body aspiration occurred. Chest and neck X-ray images revealed an asymmetric radiolucent tracheal image of the lower part of the glottis, and there was no abnormality in the lung field and mediastinum. Cervical CT revealed a membrane-like structure with a length of 10 mm and a thickness of 1 mm in the same site, and the patient was transferred to an advanced hospital due to a suspected tracheal foreign body. After transferred to the hospital, labored respiration disappeared and respiratory sound improved. On the same day, removal of the tracheal foreign body was performed under general anesthesia. After induction of anesthesia, ventilation with a bag mask became difficult, causing circulatory failure. Therefore, the rapid response system was initiated, and chest compressions had to be performed for several minutes. The foreign body was incarcerated in the part of the glottis in a form that completely obstructed the airway, and once a side of the foreign body was pushed with the bronchoscope, a slight gap was formed making ventilation possible and stabilizing the condition of the patient. The removed foreign body was a fragment of the plastic case of his father's smartphone. Extubation was performed on the forth days of admission, and an inhospital family support team intervened the family during hospitalization. The patient was discharged on the 12th days of admission without any residual disability. As in the present case, pediatric airway foreign body is a potentially fatal emergency condition. Early diagnosis, treatment, and prevention are important. Unfortunately, there are still a certain number of cases of mortality annually, so continued education for healthcare providers and legal guardians is necessary.