A potential danger of flexible endoscopy sheaths: a detached tip and how to retrieve it.

OBJECTIVE: To report an unrecognised complication of fibre-optic nasendoscopy, and its management. CASE REPORT: A protective, transparent nasendoscopy sheath is often used to reduce nasendoscope 'downtime' and to prevent cross infection, with minimal effect on the obtained image quality. We report the case of a subcutaneous tracheostomy procedure during which, without undue strain, the tip of the sheath became detached and acted as a foreign body within the trachea. A urological stone retrieval basket was used to retrieve the sheath, after failure of conventional methods. DISCUSSION: Clinicians should be aware that any instrument introduced into the airway has the potential to fail and in the process produce a foreign body which may cause serious complications. The urological stone retrieval basket may be a useful addition to the current set of instruments used to deal with difficult airway foreign bodies.