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

Verify ETT pilot line is clear of oesophagostomy tube stomas before extubation to prevent entrapment.

This case report describes a rare and novel complication in a Ragdoll cat that was anesthetized for advanced imaging of complex facial fractures sustained during a dog attack. During the same anesthetic episode, an oesophagostomy tube (OT) was placed in a retrograde fashion to support nutrition. Upon extubation, the endotracheal tube (ETT) pilot line became looped around the OT at the stoma site, causing the pilot balloon to be drawn caudally into the esophagus, preventing complete ETT removal. Anesthesia was reinduced and the trachea reintubated with a second ETT. Laryngoscopic examination revealed the pilot line receding into the esophagus and was not retrievable by gentle traction. Flexible fibreoptic endoscopy confirmed that the pilot line was wrapped around the OT, with the balloon lodged at the esophageal stoma. Endoscopic retrieval was performed successfully, the pilot line was cut, and the original ETT was fully removed. The cat recovered without further complications. This case highlights the potential for entanglement between ETTs and oesophagostomy tubes placed during the same anesthetic procedure, particularly when the OT is inserted retrogradely. Clinicians should be vigilant during extubation in patients with concurrent oesophagostomy tubes and consider systematic checks of the ETT pilot line position relative to feeding tube stomas prior to extubation. Flexible fibreoptic endoscopy proved to be an effective minimally invasive solution for managing this complication.

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