Of more than 100,000 cases of foreign body ingestion reported each year in the western world, 80 percent occur in children. Fortunately, most foreign bodies that reach the gastrointestinal tract pass spontaneously. Only 10 to 20 percent will require endoscopic removal, and less than 1 percent requires surgical intervention depending upon the foreign body. Although mortality from foreign bodies that damage the GI tract, become lodged, or have associated toxicity must be identified and removed.Presenting a case report where in a 5 year old girl presented with ingestion of a whistle while blowingit and simultaneously eating food. Whistle was impacted in the oropharynx and previous attempt to remove the whistle from the oral cavity without anaesthesia failed as the whistle was impacted.

Patient was taken up for emergency exploration and removal of whistle. Preoperative scan could not detect the upper and lower limit of the impacted whistle as it was not completely radio opaque. The challenge in this case was difficult laryngoscopy as the chances where high that the whistle could be lodged inside deeper down the airway into the trachea and bronchus. Making removal of whistle more difficult It was a difficult airway as there was obstruction in the airway for endotracheal tube insertion of appropriate size. It would be difficult or not possible at all as there was a obstruction in the airway.

The child was premedicated and the case was done under general anaesthesia. Check laryngoscopy was done after induction with incremental dosed of sevoflurane. Laryngoscopy was uneventful. Muscle relaxant was given and airway was secured with endotracheal tube. Nasal evaluation was done and whistle was pushed down and removed orally. Case was done in 20 min. Intraoperative course was uneventful .patient reverted to spontaneous ventilation at the end of surgery .patient was extubated and monitored post operatively and had good recovery.

METHODS : Laryngosopy and intubation

RESULTS : successful removal of Foreign body with uneventful intra operative course

CONCLUSIONS : management of difficult laryngoscopy and difficult airway