Abstract Introduction Foreign body aspiration in adults is uncommon and often involves food particles or dental materials. Accidental aspiration of a medication tablet with intact blister pack is rare and presents unique challenges due to the risk of mucosal trauma, airway edema, and potential obstruction. Prompt airway management and multidisciplinary coordination are crucial to prevent fatal complications. Description of Case A 59-year-old man with hypertension and diabetes accidentally aspirated a sitagliptin tablet with intact blister packaging while taking his maintenance medications. He developed sudden coughing, dyspnea, and transient cyanosis. Initial esophagogastroduodenoscopy at another institution revealed the tablet at the glottic level, prompting otolaryngology referral for extraction. Flexible nasopharyngolaryngoscopy was limited by a strong gag reflex, hence direct laryngoscopy under IV sedation was performed. Multiple extraction attempts caused bleeding and laryngeal edema, necessitating emergency tracheostomy to secure the airway. The tablet subsequently migrated deeper into the trachea, prompting bronchoscopy, which demonstrated the pill lodged just superior to the tracheostomy cannula. Extraction using flexible bronchoscopy with biopsy forceps was attempted however the packaging was partially embedded in the tracheal wall. Ultimately, the 1 × 0.5-inch tablet was extracted directly through the tracheostomy site using straight mosquito forceps. Post-operatively, the patient was managed in the ICU with corticosteroids, antibiotics, and ventilatory support. He experienced transient atrial fibrillation, which was medically controlled. By postoperative day seven, tracheostomy was decannulated with fully mobile vocal cords and no residual airway obstruction. Discussion This case highlights a rare instance of airway aspiration of a tablet with intact blister packaging that posed significant procedural and airway management challenges. The sharp, rigid material caused mucosal trauma and progressive laryngeal edema, leading to partial airway obstruction as it migrated distally. Definitive management required a coordinated approach utilizing both bronchoscopic and tracheostomy-assisted techniques to ensure safe and complete removal. Interdisciplinary collaboration between pulmonology and otolaryngology teams was essential for timely intervention, airway stabilization, and optimal postoperative recovery. This abstract is funded by: None
Legaspi et al. (Fri,) studied this question.