Penetrating Neck Injury Causing Foreign Body (Stone) in Right Lower Lobe Bronchus

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Procedures SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Penetrating neck injuries comprise of 5 to 10% of all trauma cases, potentially dangerous and require emergency management. Various vital structures like neck vessels,pharynx,trachea,esophagus,brachial plexus,peripheral nerves and cranial nerves are being unprotected, are vulnerable to trauma. We are presenting a case of accidental penetrating injury of the neck with a chip-of-stone during chiselling causing pneumomediastinum and foreign-body in the tracheobronchial tree. CASE PRESENTATION: History: A 20-year female presented to us with history of accidental penetrating injury to anterior part of the neck while chiselling stone with hammer, a chip-of-stone projected with high-velocity, hit the neck causing cough, dyspnoea & resulted in subcutaneous-emphysema. On Examination: Patient was conscious, oriented and Vitals were stable. 1×0.3cm raw wound was present without any bleeding in the anterior part of neck just below cricoid cartilage with Subcutaneous-Emphysema involving neck and upper chest. Observations: HRCT Thorax revealed pneumomediastinum with ?Foreign-body in Right lower lobe bronchus. Flexible-bronchoscopy showed laceration in anterior wall of trachea and Foreign-Body (chip-of-stone) lodged in posterolateral segmental bronchus of right lower lobe. Due to the non-availability of dormia basket, foreign-body couldn’t be removed. Foreign-body was spontaneously expelled out with cough, the next day. DISCUSSION: Tracheal injury secondary to penetrating trauma is a rare occurrence. However, if this injury goes unrecognized it can lead to serious sequelae which can become lifethreatening. A retained foreign body within the trachea or bronchus can lead to the development of airway strictures, as well as atelectasis, infection, and perforation. FOB is used for evaluation of distal airways and basic procedures such as biopsy, bronchoalveolar lavage, and suctioning of mucus plugs and blood clots. In the event of airway obstruction or failure to remove a foreign body while using FOB, it is important that a rigid bronchoscope be readily accessible CONCLUSIONS: Penetrating injury to neck is a surgical emergency need to be addressed quickly. Conservative treatment in subcutaneous-emphysema and pneumomediastinum without any life-threatening complication is favourable. Removal of foreign-bodies from the airway is essential in order to avoid complications such as tracheal-stenosis, pneumonia, bronchiectasis and foreign-body migration. This is a rare case managed conservatively and Foreign-body expelled by itself without any invasive procedures Reference #1: Elizabeth A Lax*, Sayee H Kiran and Michael W Lee. Bronchoscopic retrieval of a bullet using a Dormia basket: a case report. Lax et al. Journal of Medical Case Reports 2014, 8:358 Reference #2: Swanson KL, Edell ES: Tracheobronchial foreign bodies. Chest Surg Clin N Am 2001, 11(4):861-872 DISCLOSURE: The following authors have nothing to disclose: Narendra Umashankar, Gopal Purohit, Sunil Vyas, Isha Garg, Srikant Agarwal No Product/Research Disclosure Information