Successful retrieval of a dislodged tracheoesophageal prosthesis distal to a neopharyngeal stricture

Abstract

Objective: Tracheoesophageal prostheses (TEPs) can easily become airway or esophageal foreign bodies. We present a challenging case of TEP dislodgement in order to stimulate discussion of management and technical removal of these uniquely shaped foreign bodies. Methods: Case report and literature review. Results: A 74-year-old female presented with TEP displacement after laryngectomy tube change. Chest imaging revealed the prosthesis in the mid-esophagus, with failure of the prosthesis to pass after 24 hours. During flexible transoral esophagoscopy at the bedside, a 10-mm diameter stricture was encountered in the neopharynx just proximal to the tracheoesophageal puncture. Initial attempts to retrieve the TEP using a 13 mm short throw snare and flexible jumbo alligator forceps were unsuccessful. As an alternative strategy, the prosthesis lumen was cannulated with the forceps (jaws closed), then advanced past the distal flange of the TEP. The jaws were opened and pulled back against the distal flange, successfully dislodging the prosthesis proximally, allowing retrieval past the neopharyngeal stricture. Conclusion: TEPs are foreign bodies with slippery flanges that may not lend themselves to conventional small grasping instruments. Given its unique shape, catheterization of the TEP lumen can be taken advantage of to gain purchase for retrieval.