The Trapped Airway: A Case Of Retained Foreign Body In The Right Main Bronchus—Challenges In Anaesthesia And Airway Management.

Abstract

INTRODUCTION: Foreign body aspiration is a significant cause of morbidity and mortality in children and presents distinct challenges for the anaesthesiologist. When a foreign body remains undiagnosed or retained for a prolonged period, it can persist for years, resulting in chronic airway inflammation, recurrent infections, airway oedema, fibrosis, and progressive respiratory compromise. These long-standing pathological changes complicate diagnosis, increase anaesthetic risk, and frequently necessitate advanced airway strategies and coordinated multidisciplinary management.

CASE REPORT: We report the case of a 9-year-old female with a five-year history of recurrent cough and morning breathlessness following foreign body aspiration. The patient had undergone multiple prior airway evaluations and repeated intubations, resulting in a potentially difficult and edematous airway. Anaesthetic management required meticulous airway planning and precise lung isolation. Fibreoptic guided left endobronchial intubation was performed to maintain ventilation and facilitate right thoracotomy for surgical retrieval of the foreign body. Thoracic epidural analgesia was secured for perioperative and postoperative pain control.

DISCUSSION: Foreign body aspiration is frequently misdiagnosed, and delayed management—particularly in long-standing cases—can lead to severe airway distortion and complications that significantly impact anaesthetic safety. Thorough preoperative evaluation, anticipation of a difficult airway, invasive monitoring, and close coordination with surgical teams are essential for successful outcomes.

CONCLUSION: Foreign body aspiration is common in childhood and mandates early recognition and intervention. Prolonged retention can lead to serious or potentially fatal complications, emphasizing the importance of timely diagnosis and multidisciplinary management