Flexible Bronchoscopic Extraction Under General Anesthesia of an Intrabronchial Fishbone Embedded for One Year

Yatani Atsuhiko, Kuroda Shiori, Yamamoto Masatsugu, Tachihara Motoko, Yamada Jun, Hazama Daisuke, Katsurada Naoko, Matsumura Kou, Shimizu Nahoko, Nishimura Yoshihiro

doi:10.18907/jjsre.44.1_50

<p>Background. Bronchial foreign bodies are often difficult to extract safely after a long time has passed because of granulation or incarceration. Case. A 74-year-old woman suffered from chronic cough after swallowing a fishbone. The cause of the cough was unclear, and 1 year later, she consulted a local doctor with a chief complaint of a fever and discomfort in the left thorax, at which point she was treated for pneumonia. At that time, chest computed tomography showed left upper lobe bronchus obstruction and left upper lobe atelectasis. A foreign body was found stuck in the bronchus, but it was difficult to extract by bronchoscopy, so the patient was referred to our hospital. The bronchial wall of the left main bronchus was edematous. A foreign body resembling a fishbone was observed at the bifurcation of the left upper and lower lobe bronchus, and the orifice of the left upper lobe bronchus was narrowed due to granulation. We administered prednisolone at 40 mg/day for 3 days to improve the bronchial edema before extracting the fishbone with a flexible bronchoscope under general anesthesia. We found that bronchial edema had been improved. Transient positive airway pressure was effective in expanding the bronchial lumen and extracting the fishbone stuck in the bronchus. We succeeded in extracting the fishbone using alligator biopsy forceps. Conclusion. We improved the bronchial edema with the preadministration of prednisolone and expanded the bronchial lumen under general anesthesia to control breathing and the cough reflex, thereby extracting the intrabronchial fishbone.</p>

Flexible Bronchoscopic Extraction Under General Anesthesia of an Intrabronchial Fishbone Embedded for One Year

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