Spinal anaesthesia in acute colonic pseudo‐obstruction

We believe that the mass was a tongue of tumour that had broken loose from the main lesion during manipulation of the lobes and had been dislodged from the right side into the left bronchus by either coughing or a suction catheter drawing on the bolus out at the time of extubation. We agree with Dr Tzabar that whilst occlusion of the airway by free tumour mass is rare, it is a problem that should be considered when respiratory difficulty is experienced after treatment of thoracic tumours. We concur with the difficulty that may arise in making the diagnosis, but prompt investigation by bronchoscopy and treatment immediately resolves the problem. the cyanosis was due to poor respiratory effort, but adequate reversal of anaesthesia was confirmed. The inspiratory oxygen concentration was increased and verbal encouragement to improve respiratory effort was offered. Following an absence of improvement in condition, re-examination demonstrated that the left chest was not expanding well and there was poor air entry. A chest X ray was performed and demonstrated complete collapse of the left lung, but a well expanded right upper lobe (Fig. 1). A rigid bronchoscopy was undertaken urgently and the left main bronchus found to be occluded by a bolus of tissue, 1.5 x 1 cm in size. The bolus was removed and was followed by immediate recovery of normal ventilation. The bolus was hard and histological examination demonstrated that it had the same characteristics as the tumour in the right lower lobe. Guy’s Hospital, London SEl9RT C.M.R. SATUR A.B. CHURCH O.J. LAU