Broken Metallic Tracheostomy Tube Migrating into the Tracheobronchial Tree

Abstract

Foreign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson's disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening.

Aspiration of a fractured tracheostomy tube, a rare complication of tracheotomy: the factors involved in this incident and literature review

“…Rigid bronchoscopy is the preferred procedure for removal of large foreign bodies in approximately 75%. 3,5,6,[9][10][11][13][14][15]17,19,20,22 In general, rigid grasping forceps is used for removal; however, in our case the proximal end of the tube was severely corroded, and might be broken during grasping.…”

“…19 The analysis of these last reviews of the literature objective the presentation of 75% of cases in a state of respiratory distress hence the interest in preventing this potentially fatal accident. 3,5,[8][9][10][11][13][14][15]17,20,21 However, the discovery may sometimes be fortuitous, or the patient is almost asymptomatic after inhalation for the other remaining cases. 6 Standard radiology retains all its indications, given the importance of differential diagnoses of dyspnea and atypical presentation especially in the elderly, this additional examination remains accessible in emergency with a major diagnostic value.…”