Stoma buttons - an unreported hazard

Aspirated stoma button: an unusual complication

“…Aspiration of a stoma button is indeed a recognized event; however, in other reports to date, the stoma button has been successfully retrieved through the tracheostome without complication. 4 The reasons for the late presentation in this case were, firstly, the failure to notice the loss of, or possible aspiration of, the stoma button, and, secondly, the fact that the stoma button, which has a reasonably sized lumen, was lodged in the left main bronchus causing only partial obstruction, with little in the way of symptoms. The latter would explain the lack of acute symptoms and the subsequent delay in diagnosis.…”

“…Objects which are aspirated by these patients include devices which are used to keep the stoma patent and clean, such as stoma buttons, tracheostomy tubes, cleaning brushes and various other inanimate objects. 2,4,5,7 In the majority of patients, inhalation or aspiration of a foreign body, either accidentally or iatrogenically, presents as a sudden emergency as it causes considerable difficulty in breathing and severe respiratory distress. 8,9 Usually, the foreign body is retrieved easily, using flexible or rigid endoscopy and suitable forceps, via the tracheostome.…”

“…They are radio-opaque but manufactures warn that they will not be visible in the midst of radio-dense structures such as the mediastinum. 4 Stoma buttons are flesh-coloured for cosmetic purposes, which makes recognition difficult at bronchoscopy.…”

“…2,3 Sometimes the foreign bodies aspirated by the patient can be the devices specifically developed to maintain the patency of the tracheostome. 4,5 Inhaled foreign bodies can cause severe problems in the form of acute respiratory distress [3][4][5] or present later with repeated chest infection, pneumonia or other serious pulmonary complications. 6 Hence, any patient in whom the laryngeal airway is bypassed and who is displaying chest symptoms should be thoroughly investigated.…”

Removal of an inhaled stoma button distal to a reactionary tracheal stenosis: a difficult airway case

“…Manufacturers of stoma buttons offer the button in flesh colour for optimal cosmesis, however this can make identification during bronchoscopy more difficult 1. Stoma buttons are radio-opaque but are not easily visualised in more radio-opaque regions like the mediastinum 2…”