Catastrophic Endobronchial Haemorrhage During Rigid Bronchoscopy: A Case Report Highlighting Human Factors

Abstract

Rigid bronchoscopy is central to the management of foreign body aspiration and haemoptysis. Catastrophic endobronchial bleeding remains rare but life threatening. We report a 60 year old man referred with a presumed chronic right lower lobe foreign body. Rigid bronchoscopy identified a firm endobronchial lesion. Piecemeal removal precipitated torrential haemorrhage with rapid desaturation and pulseless electrical activity arrest. Immediate wedging of the rigid bronchoscope achieved partial tamponade but failed to control bleeding. Emergency tracheostomy enabled salvage thoracotomy and right lower lobectomy, with restoration of haemodynamic stability. Histology demonstrated follicular lymphoma and pulmonary hamartoma. The patient made an uneventful recovery. This case identifies the technical principles of airway tamponade and prompt progression to definitive surgery, and highlights the importance of communication, situational awareness, and emotional regulation in managing thoracic surgical emergencies.