CLINICAL IMAGE
An 85-year-old man with a 2-day history of dyspnea and general malaise was admitted to our hospital with hypopnea and acidosis. Chest radiograph and CT scan identified a round high-density shadow about 1cm in diameter (Figure 1). We deduced that a pachinko-ball (Pachinko is a Japanese pinball gambling game) obstructed the right inferior lobar bronchus. Forced coughing and back blow failed to remove it. To remove the obstacle with minimal invasion, we considered several devices with an endoscope under mechanical ventilation; a magnet, a basket type or a pentatope type grasping forceps, or an endoscopic net forceps, with the support of a laryngeal mask airway, which we selected. The pachinko ball was successfully retrieved without severe damage to the patient (Figure 2). The patient received non-invasive positive-pressure ventilation for one day and antibiotic administration for 14 days. Rehabilitation improved his general condition, and he was transferred to a long-term hospital on day 48. There is no consensus on how to retrieve a metallic round ball from an airway. Based on our experience, we propose that endoscopic net forceps with the support of a laryngeal mask airway is a dependable choice for such occasions.
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