アルカリ性洗剤の誤飲により急速に生じた上気道狭窄例

抄録

I report the case of a patient who developed rapid upper airway narrowing following accidental ingestion of an alkaline detergent that necessitated emergency tracheotomy. A man in his forties visited the emergency department of our hospital complaining of a sore throat after accidentally ingesting an alkaline detergent. About 1.5 hours after ingestion of the detergent, he started to experience difficulty in breathing. At 2 hours after the ingestion, the patient developed wheezing of gradually worsening severity. I attempted orotracheal intubation at about 2.5 hours after the accidental ingestion, which, however, proved impossible because of glottic stenosis caused by laryngopharyngeal edema. Tracheotomy was performed, which saved the patient’s life. The patient was admitted to the intensive care unit and initiated on artificial mechanical ventilation. On the 7^th day of hospitalization, the patient could be weaned off the ventilator. By the 9^th day of hospitalization, the laryngopharyngeal edema had resolved, the tracheal cannula was removed, and the patient resumed oral meal intake. On the 16^th day of hospitalization, the patient was discharged home in a satisfactory general condition. One year after the accidental ingestion, no gastrointestinal stricture was observed.

Since laryngopharyngeal edema may occur rapidly after ingestion of a corrosive substance, we should pay attention to changes in the respiratory status over time and promptly undertake emergency airway management when necessary, with either endotracheal intubation or surgical airway management.