|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 318-319
Maggots: bronchoscopic removal of a rare live foreign body
Pulak Tosh, Sunil Rajan, Jerry Paul, Lakshmi Kumar
Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
|Date of Submission||15-Jan-2018|
|Date of Acceptance||30-Jul-2018|
|Date of Web Publication||29-Sep-2020|
DA,DNB Sunil Rajan
Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi-682041
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tosh P, Rajan S, Paul J, Kumar L. Maggots: bronchoscopic removal of a rare live foreign body. Res Opin Anesth Intensive Care 2020;7:318-9
|How to cite this URL:|
Tosh P, Rajan S, Paul J, Kumar L. Maggots: bronchoscopic removal of a rare live foreign body. Res Opin Anesth Intensive Care [serial online] 2020 [cited 2020 Oct 23];7:318-9. Available from: http://www.roaic.eg.net/text.asp?2020/7/3/318/296614
The patient, a 36-year-old woman, was diagnosed to have tongue carcinoma, who had undergone total glossectomy with radical neck dissection and on metal tracheostomy. Postoperatively, she had completed 17 fractions of radiation and three cycles of concurrent weekly cisplatin. Two months later, she presented with generalized weakness and fever with continuous cough. On examination, there was induration and sloughing around the tracheostomy area with multiple tunnels teaming with maggots. Maggots were coming out of the trachea and the patient was coughing them out. The patient was posted for debridement of the area with removal of maggots from the tracheobronchial tree, on an emergency basis. She was fasting for more than 12 h.
An attempt of awake bronchoscopy failed as she was very uncooperative and was not willing for any instrumentation of the airway. So, general anesthesia was chosen. After keeping fiberoptic bronchoscope ready, induction was done with fentanyl 100 μg followed by propofol 100 mg. Once patient lost consciousness, suxamethonium 100 mg was given intravenously. Then the metal tracheostomy tube was removed, a 7 mm cuffed endotracheal tube was passed and cuff inflated. Through the endotracheal tube fiberoptic bronchoscope was passed and two maggots were removed from the right main bronchus, each time applying continuous suction and taking out the fiberoptic brochoscope. The rest of the tracheobronchial tree, as far as visible, remained clear.
Anesthesia was maintained with oxygen with sevoflurane (1–2%) and further relaxation was provided with atracurium 0.5 mg/kg. The area around the tracheostomy stoma was debrided and more than 100 maggots were removed. The patient was reversed and put on cuffed tracheostomy tube at the end of surgery. She received antibiotics and daily dressings and made an uneventful recovery. Two months later indirect laryngoscopy showed laryngeal involvement and total laryngectomy with free jejunal flap reconstruction was performed.
| Discussion|| |
Aspiration of live foreign bodies is not common unlike objects such as peanuts, melon seeds, and beans. Though maggots removal from the tracheostoma has been reported ,,, its aspiration is a rare occurrence and is not reported so far. Although there are reports of tracheoesophageal prosthesis aspiration in laryngectomized patients  aspiration in a tracheostomized patient is rare. Foreign body removal from the trachea and bronchi are best accomplished with a fiberoptic bronchoscope .
Maggot infestation of surgical wounds had been reported mostly from tropical countries. Poor hygiene and bad odour are the common predisposing conditions. In our patient immunosuppression following radiation, chemotherapy, malnutrition, and cachexia secondary to malignancy would have been additional factors which favored tracheostomal myiasis. Usually maggot aspiration is prevented by the protective airway reflexes which help to cough out any maggot which might enter the airway. The maggots which we removed from the trachea would have gained entry after induction of anesthesia with subsequent loss of cough reflex. We opted for fibreoptic bronchoscopic removal as rigid bronchoscopy would take a longer time and with delay maggots might move to distal airway, which are difficult to access for removal even with a flexible bronchoscope.
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Conflicts of interest
There are no conflicts of interest.
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