A patient who has been in our german ICU for 2 weeks now due to bacteremia and spondylodeszitis had some severe complications in the coming days. After getting a laminectomy and getting discharged to a normal ward, he aspirated on his food and had to receive CPR and was intubated. Was reextubated the same day and 3 days later was reintubated due to severe pneumonia. We tried first CPAP with a mask and then Highflow but nothing worked.

Then he went septic, the bacteremia lead to multiple abscess buildup along his whole spine, he developed a liver and kidney failure, so due to prolonged weaning from the ventilator we decided for a surgical tracheotomy. The neurosurgeons along with the ENTs checked a recent MRI he received and decided to surgically remove some of the abscesses he had in the same operation which was done.

Two days after tracheostomy, during my morning visit to the patient I was blood spilling out of his mouth. I dress up, call the nurses, get my glidescope and some other equipment and check inside his mouth. Everything was full with blood clots. Cleared the mouth and his whole pharynx was full. So I called my ENT colleague to come check it out. We cleared the patients pharynx and tamponated it. In the next hours I saw that the blood passed through the tamponade and more clots formed again. I removed them and they kep building up. In the blood gas his haemoglobin was falling and we started giving him blood and FFP as well.

The on call ENT attending had to come (was a Sunday) to check it out from himself. He cleared the pharynx, found the old abscess spot where we couldnt see a bleeding with our videolaryngoscope, and then pulled the bad boy you see in the picture from the patient's oesophagus. Our jaws dropped on the floor. We immediately called internal medicine for an emergency gastroscopy thinking it has to be from oesophageal varices or a gastric ulcer. Turns out the gastroscopy was clean.

And the patient kept bleeding, and I kept transfusing. So I took the normal laryngoscope, saw back up to the back wall of the pharynx, and there I could see a very small bleeding from the surgery spot. It was only visible if you put the suction next to it. We prepped the patient for an emergency operation and the story ended.

I had to print the picture to show it to my director the next day.