[A case of massive hemorrhage associated with the removal of longstanding intrabronchial foreign body]

Abstract

A 46 year old male patient was admitted with fever and cough. A chest X-ray film revealed a foreign body shadow of a denture fragment in the right intermediate bronchus that he had swallowed one year and half ago. Rigid bronchoscopy was used to remove the foreign body under general anesthesia. During the procedure, massive hemorrhage occurred from bronchus, and the foreign body was not removed successfully and the patient sustained near cardiac arrest. Postoperatively, he recovered from the near fatal condition with support of mechanical ventilation in ICU for several days. After one month, pulmonary angiography was performed and it revealed the transfiguration of pulmonary artery and other vessels close to the foreign body. Granular tissue around the foreign body was observed by preoperative bronchoscopy. Disruption of such vessels and granular tissue by rigid and forced fiberscopy was suspected to have caused the massive bleeding. Later, the denture fragment was successfully removed by right thoracotomy. We should take this complication into consideration and preoperative fiberoptic bronchoscopy and pulmonary angiography may be beneficial to the anesthetic management of such patients.