Nakamura Motohiro, Hisamura Masaki, Hashimoto Masayuki, Sawano Makoto, Joshita Midori, Toi Takahiro, Asano Yoshitaka, Matsueda Hideyo, Arima Fumihito, Oi Hidenori, Kitawaki Takehiro, Ando Yoji, Koshimizu Kenji
Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
Department of Emergency Medicine and Critical Care, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
Respir Med Case Rep. 2017 Mar 19;21:36-38. doi: 10.1016/j.rmcr.2017.03.012. eCollection 2017.
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.
