Abstract Introduction Tracheobronchial foreign body aspiration in adults is uncommon, with chicken bones presenting unique extraction challenges due to their irregular morphology and fragmentation potential. This case demonstrates successful management of a complex wishbone aspiration using rigid bronchoscopy with controlled fragmentation. Case Description A 30-year-old male with Marfan syndrome, prior spontaneous pneumothorax with pleurodesis, and obstructive sleep apnea presented with 10-day history of hemoptysis following a choking episode while eating chicken. Computed tomography demonstrated a 3-cm irregular radiopaque foreign body overlying the main carina and extending into the left mainstem bronchus. Under general anesthesia, rigid bronchoscopy was performed using a 13.2-mm Dumon tracheoscope. A bony structure was visualized in the airway, with the short limb in the left mainstem bronchus, and the longer limbs across the main carina, and the superior left main bronchus. Using two sets of rigid forceps, rotational force was applied to each limb, successfully breaking the structure into three pieces. Two fragments were extracted via rigid forceps through the tracheoscope. Following removal of the tracheoscope and re-intubation, flexible bronchoscopy was used to retrieve the remaining fragment. The extracted foreign bodies were then identified to be a chicken wishbone. Complete hemostasis was achieved without complication. The patient was discharged home the same day with resolution of hemoptysis and no residual symptoms. Discussion Rigid bronchoscopy remains the gold standard for complex tracheobronchial foreign body extraction. Controlled fragmentation may be necessary for irregularly shaped objects that are impacted at airway bifurcations. In this case, the morphology of the impacted object precluded removal via traditional methods given an inability to pass the object in its entirety through the endotracheal tube, as well as a high likelihood of damage to surrounding structures, including mucosal perforation or vocal cord injury. Prompt recognition and rigid bronchoscopic management enables safe extraction of complex tracheobronchial foreign bodies with excellent clinical outcomes. This abstract is funded by: None
Rathell et al. (Fri,) studied this question.