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Gastrointestinal stromal tumors (GISTs) are infrequent mesenchymal malignancies arising from the gastrointestinal tract (GIT), accounting for only 0.2% of all GI malignant neoplasms (1). Approximately 60% of GISTs arise in the stomach, 30% in the jejunum and ileum, 4-5% in the duodenum, 4% in the rectum, 1-2% in the colon and appendix, and <1% in the esophagus. Their estimated incidence, including incidental neoplasm, is 10-20 per million (2). The majority are characterized by the oncogenic mutation in either of the two related receptor tyrosine kinases: KIT-CD117 (75-80%) or PDGFRA (platelet-derived growth factor) (5-10%) (3). Recently, extra-gastrointestinal stromal tumors (EGISTs) showing features of GIST have been described at extra-gastrointestinal sites including the omentum, mesentery and retroperitoneal space (4,5). The clinical features and treatment of EGISTs are not well known since there have been only a few cases. To the best of our knowledge, there has been no report of a primary EGIST originating from the broad ligament of the uterus.

We describe the novel combined use of a fiberoptic bronchoscope and a Fuji Uniblocker placed outside the endotracheal tube (ETT) for removal of a retained BioGlue polymerized tissue fragment (2.8 × 0.8 cm) from the right main bronchus (RMB). The patient was a trauma victim who presented with a diffuse axonal injury, cervical spine and maxillofacial injuries, and a flail chest, and the procedure we describe took place following the surgical repair of a disrupted left main bronchus. Endoscopic retrieval using different sizes of grasping forceps and a Dormia basket failed to remove the foreign body (FB). Under combined GlideScope videolaryngoscopic and bronchoscopic guidance, a 9.0 F Uniblocker was introduced outside the ETT, placed into the RMB beyond the FB, initially inflated, and then gradually increased in volume during withdrawal from the RMB into the trachea so as to trap the FB between the tip of the ETT and the blocker balloon. The ETT, bronchoscope, blocker catheter, and the FB were then removed from the glottis as a single unit. The FB was then removed using Magill forceps with the aid of a GlideScope. We conclude that the combined use of a GlideScope, bronchoscope, and an Uniblocker placed outside the ETT can be an effective method for removal of a retained FB.

No abstract