Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway

• Published in: Respiratory medicine case reports 2017-01, Vol.21 (C), p.36-38
• Main Authors: Nakamura, Motohiro, MD, PhD, Hisamura, Masaki, MD, PhD, Hashimoto, Masayuki, MD, Sawano, Makoto, MD PhD, Joshita, Midori, MD, Toi, Takahiro, MD, Asano, Yoshitaka, MD, Matsueda, Hideyo, MD, Arima, Fumihito, MD, Oi, Hidenori, MD, Kitawaki, Takehiro, ME, Ando, Yoji, MD, Koshimizu, Kenji, MD, PhD
• Format: Article
• Language: English
• Subjects: Anorexia nervosa; Bronchoscopy; Case Report; Internal Medicine; Pulmonary/Respiratory; Tracheal membranous obstruction; Tracheotomy
• ISSN: 2213-0071; 2213-0071
• DOI: 10.1016/j.rmcr.2017.03.012

Abstract We report a rare case of acquired membranous tracheal stenosis in a patient with anorexia nervosa and a history of self-induced vomiting, but without a history of tracheal intubation or tracheostomy. A 50-year-old woman presented with difficulty in breathing and swallowing, self-expectoration, and impaired consciousness due to acute benzodiazepine intoxication. Bronchoscopic examination was performed after tracheotomy and placement of a tracheostomy tube failed to secure her respiratory tract and ventilation continued to deteriorate. A flap-like membranous structure was identified on the posterior tracheal wall, obstructing the tracheostomy tube. Physical compression of the membranous structure improved ventilation. Bronchoscopic examination is generally recommended prior to performing tracheostomy in patients suspected to have post-intubation tracheal obstruction. Based on our findings, we suggest that these examinations should also be performed in patients with conditions associated with chronic irritation of the respiratory tract, including those with a prolonged history of self-induced vomiting.