PMC6364118_01
The first episode of FB aspiration and ingestion. (a) PA radiography on admission. (b) Mediastinal emphysema at thoracotomy. (c) FB (arrow) protruding through the left main bronchus (insert: FB removed). (d) Laparotomy and gastrotomy. (e) Metallic FBs removed from the stomach.
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At thoracotomy, a significant mediastinal emphysema (Figure 1(b)), together with diffuse adhesions, was noticed. After the lung liberation, a proximal 0.5 cm of the noncurved part of the metallic hook was found to protrude through the perforated membranous wall of the left main bronchus, 1 cm away from the descending aorta (Figure 1(c), arrow). The FB was removed from the bronchus (insert on Figure 1(c)) without the need for additional bronchotomy. After the thoracotomy closure, laparotomy was done and several sharp metallic pieces of different shapes were removed from the stomach (Figures 1(d) and 1(e)). The abdominal radiography revealed metallic pieces in the digestive tract as well (Figure 1(c)).
Repeated FB aspiration and ingestion. (a,b) CT of the thorax on admission. (c) FBs in the abdomen. (d) Illustration of the bronchoscopic maneuvers. (e) Metallic FB removed.
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After three years, the patient was urgently readmitted for the new episode of the metallic foreign body aspiration (Figures 2(a) and 2(b)). Because of the curved shape of the FB and the impossibility to remove it through the instrument, the FB and bronchoscope were pulled out from the patient together, with the FB firmly grasped, followed by reintubation with the same bronchoscope (Figures 2(d) and 2(e)).