Navigating Intraoperative Dislodgement: Anaesthetic Management in Foreign Body Retrieval with Bronchotomy and Fibre-optic Bronchoscopy

Foreign body aspiration, particularly in the lower airway, presents unique challenges for anaesthesiologists, especially when dislodgement occurs during surgical manipulation. We report the case of a 21-year-old male who presented with an iron nail lodged in the left lower lobe of the lung, with a history of failed removal using flexible and rigid bronchoscopy. After unsuccessful attempts, the patient underwent left thoracotomy for foreign body retrieval. During the procedure, the foreign body dislodged into the tracheal wall through the Murphy eye of the endotracheal tube. A multimodal approach involving fiber-optic bronchoscopy and bronchotomy ultimately led to successful retrieval. The anesthetic strategy involved maintaining spontaneous ventilation and total intravenous anesthesia (TIVA). This case highlights the importance of coordinated management between anesthetic and surgical teams in handling complex foreign body retrievals.