An Unusual Airway Foreign Body: A Cockroach in the Trachea

We present a case of airway obstruction by an unusual foreign body in a 10 month old male. The child was brought intubated to the emergency room after he was found unconscious and blue by his parents. His older sibling reported a choking episode after he placed a black object in his mouth. Chest x-ray on arrival demonstrated right-sided air trapping but no definite radio-opaque foreign body. Due to difficulty with ventilation and post-obstructive pulmonary edema on initial bronchoscopy, emergent extracorporeal membrane oxygenation (ECMO) was initiated to help stabilize the patient. Subsequent bronchoscopy demonstrated near total obstruction of the mid-trachea by an insect-like object. The object removed appeared to be a common American cockroach. Airway foreign body retrieval is a common part of otolaryngology practice. Most of the time, these foreign bodies are food materials or other inanimate objects. Finding a cockroach in the airway is incredibly rare and only three cases have been reported in the literature. This case also illustrates that ECMO may be considered in a patient too unstable to tolerate temporary withdrawal of ventilatory support for endoscopy. Additionally, rapid diagnosis and treatment is important when caring for a child with suspected foreign body aspiration.