Patients with a known difficult airway for intubation who present with intestinal obstruction are at an increased risk for receiving general anesthesia. It may be necessary to perform an awake fiberoptic intubation, or possibly a tracheostomy if an awake intubation cannot be performed. In some cases, an awake tracheostomy may not be possible due to the anatomy. We report a case in which a patient with extreme fixed neck flexion deformity in whom a tracheostomy would not have been possible, presented for emergency abdominal surgery.
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