title: Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway.
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.
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Hisamura
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Emergency Medicine and Critical Care, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sawano
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Joshita
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toi
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Asano
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Hideyo
authors.initials: H
authors.lastname: Matsueda
authors.affiliation: Department of Emergency Medicine and Critical Care, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Fumihito
authors.initials: F
authors.lastname: Arima
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Oi
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kitawaki
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Emergency Medicine, Saitama Medical Centre, Saitama Medical University, Kamoda Kawagoe City, Saitama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Koshimizu
keywords: Anorexia nervosa; Bronchoscopy; Tracheal membranous obstruction; Tracheotomy