Fibreoptic endoscopic retrieval of an endotracheal tube pilot balloon lodged in the oesophagus following entanglement with a feeding tube.

Complications associated with both endotracheal tubes (ETTs) and oesophagostomy tubes (OTs) are common, but rarely involve both simultaneously. This report describes a novel case of ETT pilot balloon entanglement with an OT, resulting in complete entrapment of the balloon within the oesophagus after extubation, and provides the first description of minimally invasive management using flexible fibreoptic endoscopy. A Ragdoll cat was anaesthetised, including placement of an ETT, for advanced imaging of complex facial fractures sustained during a dog attack. During the same anaesthetic, an OT was placed in a retrograde fashion to manage anorexia and support nutrition during stabilisation and healing. During extubation, the cuff was deflated, as the pilot balloon was externally visible, and the ETT was fully removed from the trachea; however, it remained attached to the patient because the pilot line was looped around the OT at the stoma site, causing the pilot balloon to be drawn caudally into the oesophagus and preventing complete removal. Anaesthesia was reinduced, and the trachea was reintubated with a second ETT. Laryngoscopic examination revealed that the pilot line was receding into the oesophagus and could not be retrieved by gentle traction. Flexible fibreoptic endoscopy confirmed that the pilot line was wrapped around the OT and that the balloon was lodged at the oesophageal stoma, where it had been displaced following extubation. The balloon was successfully retrieved endoscopically, and the pilot line cut to allow complete removal of the first entangled ETT. The cat recovered uneventfully from this complication.