A 35-year-old gentleman with underlying depression
presented with noisy breathing and difficulty in breathing and was
brought to emergency department by one of his family members.
On examination, he was cyanosed and aphonia and an attempt
of intubation was tried by an experienced anesthetist but failed.
There was ‘no airway’ noticed except for pooling of secretions.
The insertion of laryngeal mask airway also failed as there was
resistance at the level of oropharynx. In view of rapid desaturation,
cricothyroidotomy was performed to secure his airway. Computed
tomography of the neck showed an expanded oropharynx (Figure
1). Examination under anesthesia revealed a huge plastic ball
swallowed by the patient (Figure 2). It was removed and the
cricothyroidotomy was converted to orotracheal intubation. Then
he was successfully extubated the next day.
Oropharyngeal translucent foreign body (plastic ball). Airway
foreign body is uncommon in healthy young adults. There is a broad
range of presentation from subtle to acute life-threatening airway
obstruction. One large-city series of ambulance- transported airway
foreign body patients reports a 3.3% mortality (an average of one
patient per month) in the prehospital phase alone . History of
ingestion of foreign body, inability to swallow and odynophagia
are the most important diagnostic criteria . However, it could
be challenging among those mentally challenged patients where
the history is usually unclear . Therefore, emergency physicians
must have high suspicion for foreign body impaction in mind in dealing with this group of patients who present with airway
issues. Experienced anesthetist, otolaryngologist must be called in
immediately to help out in this kind of difficult airway scenario. In
our case, there was a totally occluded airway as the plastic toy ball
stuck in oropharynx till cricothyroidotomy was needed. Imaging is
usually a useful tool to help locate and delineate the foreign body,
but it might be missed in unexperienced hands.