Case Report: Oesophageal Foreign Body in a Patient with Multiple Congenital Anomalies: A Case Report On the Role of C-MAC® Videolaryngoscopy and Rigid Oesophagoscopy

Abstract

<ns3:p> Introduction Managing esophageal foreign bodies in cognitively impaired adults with multiple congenital anomalies presents different complex challenges, particularly when anatomical abnormalities, airway anomalies, and behavioral disturbances are present at the same time. These underlying factors can complicate both diagnosis and treatment, necessitating a highly individualized and multidisciplinary approach. This case shows the importance of a multidisciplinary approach involving videolaryngoscopic intubation, flexible endoscopy, and rigid oesophagoscopy. Case Presentation A 32-year-old male with multiple congenital anomalies—including microcephaly, cognitive impairment, epilepsy, severe kyphoscoliosis, and lower limb muscle atrophy—presented with acute dysphagia. CT imaging revealed a calcified foreign body lodged within a multidiverticular oesophagus in its cervical portion, along with a sliding hiatal hernia. Due to behavioural unpredictability and risk of aspiration, awake fibreoptic intubation was considered unsafe. A modified rapid sequence induction using propofol and C-MAC <ns3:sup>®</ns3:sup> videolaryngoscopy enabled successful first-pass intubation. Flexible endoscopy was initially misdirected into a large proximal diverticulum, leading the team to proceed with rigid oesophagoscopy. The ENT team successfully retrieved multiple bone fragments. Postoperative respiratory distress was managed conservatively, without reintubation. Clinical Discussion This case underlines the significance of interdisciplinary coordination and the limitations of flexible endoscopy in altered oesophageal anatomy. Videolaryngoscopy proved essential in managing a complex airway scenario. Conclusion Tailored, proactive strategies involving anaesthetists, ENT, and gastroenterology teams are essential in similar high-risk settings to ensure procedural success. </ns3:p>