Video-assisted thoracoscopic lobectomy for a migrated duck bone foreign body complicated by severe peribronchial inflammation: a case report

Introduction and importance: Foreign body aspiration (FBA) in adults presents diagnostic challenges, particularly in patients with communication barriers. Delayed diagnosis can lead to severe complications, including recurrent pneumonia and bronchiectasis. While bronchoscopy is the first-line treatment, surgical intervention becomes necessary when extensive inflammation precludes safe endoscopic retrieval. Case presentation: A 56-year-old male with a long-standing psychiatric disorder (schizophrenia) presented with an 8-month history of refractory respiratory symptoms. Chest computed tomography revealed a right lower lobe bronchial obstruction. Bronchoscopy identified a bone-like foreign body embedded in granulation tissue. Multiple endoscopic retrieval attempts failed, necessitating video-assisted thoracoscopic (VATS) right lower lobectomy. The surgical specimen confirmed a duck bone as the causative agent. Clinical discussion: This case highlights the diagnostic difficulty in special populations where history-taking is compromised, and the management challenge when organic foreign bodies provoke severe peribronchial inflammation. The 8-month impaction period resulted in a significant tissue reaction that rendered bronchoscopic extraction hazardous. VATS lobectomy provided definitive treatment while allowing precise dissection in the setting of obliterated tissue planes. Conclusion: For complex FBA cases with irreversible pulmonary damage and failed endoscopic management, VATS lobectomy represents a safe and curative approach. Early surgical consultation should be considered when encountering chronic foreign bodies with significant peribronchial inflammatory changes.