Management Of Foreign Body Aspiration Research Articles

Comparison of rigid bronchoscopy and flexible bronchoscopy for the management of foreign body aspiration in children

ObjectiveTo compare clinical outcomes of flexible and rigid bronchoscopies for the management of foreign body aspiration (FBA) in different airway locations, especially in unilateral main bronchus, in children, so as to provide some suggestions to assist clinical decisions. MethodsThe medical records of children diagnosed with FBA in Qingdao Women and Children's Hospital Affiliated to Qingdao University from January 2020 to June 2022 were retrospectively reviewed. The following information was collected: demographics, radiological findings, endoscopic findings, foreign body locations, duration of operation, operation cost, and intraoperative and postoperative complications. Results182 children were included in the study with the median age of 1.3 years (interquatile range, 1.0–1.8). Among whom, 124 cases (68.1 %) were male and 58 cases (31.9 %) were female. 11 cases (6.0 %) had the foreign bodies located in the trachea (larynx to carina), 3 cases (1.6 %) located in the trachea and lower bronchus, 1 case (0.5 %) located in bilateral main bronchus, 135 cases (74.2 %) located in unilateral main bronchus, 4 cases (2.2 %) located in main and lobar bronchus, and 28 cases (15.4 %) located in the lobar or segmental bronchus. Among all the included children, 84 cases (46.2 %) received rigid bronchoscopy (RB) and 98 cases (53.8 %) received flexible bronchoscopy (FB). 131 cases with the foreign bodies located in unilateral main bronchus received one type of bronchoscopy (RB or FB). They were divided into two groups according to the location of foreign body relative to the midpoint of main bronchus, the proximal bronchus group and the distal bronchus group. In the proximal bronchus group, duration of operation using RB and FB was 15 (12.5–27.5) min and 15 (14.5–30.0) min, respectively (Z = 0.000, P = 1.000). The intraoperative and postoperative complication rate using RB and FB was 15.4 % and 9.1 %, respectively (χ2 = 0.008, P = 0.927). Operation cost of FB was significantly higher than that of RB (t = −13.396, P = 0.000). In the distal bronchus group, duration of operation using RB was 20 (13.5–25.0) min, which was drastically shorter than that of FB (25 (20.0–35.0) min) (Z = −2.947, P=0.003). Operation cost of FB was still found to be significantly higher than RB (t = −20.456, P=0.000). No significant difference was found in complication rate of RB (14.3%) compared to FB (8.3%) (χ2=0.251, P=0.616). ConclusionsWhen foreign bodies are lodged in unilateral main bronchus, RB could be chosen as the first-choice procedure with advantages in duration of operation and operation cost, especially for patients in China. Regardless of duration of operation and operation cost, FB is also a safe and efficient therapeutic procedure to remove inhaled foreign bodies in children, except for those located in the trachea and asphyxiating foreign bodies.

Management of Foreign Body Aspiration in Children: Insights From 664 Cases in the Operating Room

Tracheal or bronchial foreign body aspiration is an important emergency o childhood requiring bronchoscopy under general anesthesia. In this retrospective study, bronchoscopy were performed for foreign body aspiration; anesthesia methods, risks, and postoperative complications were evaluated. Children who underwent bronchoscopy with suspicion of a foreign body in the pediatric surgery operating room between January 2010 and December 2021 were included in the study. Six hundred and sixty four children were evaluated. General anesthesia was applied to all bronchoscopy. Demographic characteristics of the patients, type of foreign body, localization of foreign body, distribution of foreign body according to age groups, complications related to anesthesia and surgical process, length of stay in the postoperative intensive care unit, and duration of hospital stay were evaluated. The patients who aspirated foreign bodies most frequently were children aged 1-3 years (73.6%). During bronchoscopy, organic matter (seeds, hazelnuts, peanuts, chickpeas) was the most frequently removed foreign body in children (559 patients). It was observed that foreign bodies were mostly located in the right main bronchus at a rate of 52.4%, the left main bronchus at 28%. The most common anesthesia-related complications were desaturation in 400 patients, hypercarbia in 200 patients, bronchospasm in 108 patients, and respiratory arrest in 2 patients. Many problems may be encountered in foreign body inhalation, and bronchoscopy of these patients should be performed by an experienced anesthesiologist and surgeon at the right time and in the safest way in terms of anesthesia and surgery.

Parental Role in Recognition, Prevention and First Aid Management of Foreign Body Aspiration amongst Children

Background: Foreign body aspiration (FBA) is a commonly observed, fatal but preventable condition in children. To reduce the incidence of FBA, it is essential to provide parents with knowledge and guidelines regarding the prevention and management of FBA. Objectives: To assess parental knowledge and parental role in the prevention and first aid management of foreign body aspiration in children. Methods: A descriptive cross-sectional study was carried out at Mayo Hospital, Lahore from January 2019 to September 2019. After IRB approval and informed consent, 151 parents were enrolled through convenient sampling. Data were recorded in a structured questionnaire and analyzed through SPSS version 26. Results: Breathlessness and vomiting were recognized as symptoms of FBA by 49.7% & 7.3% of parents respectively. Hand clutched to throat, color & voice change were recognized as signs by 6.6 %, 9.9 % &10.6 % of the parents. As a first aid measure, 66.2% of individuals knew about back slaps, while only 2% were aware of abdominal thrusts. Literate parents were well aware of the facts that children under the age of three should not consume seeds, hazelnuts, and hard nuts and the child should not laugh or talk while eating compared to illiterate parents (p<0.05) Conclusion: The majority of the parents are not well aware of signs, symptoms, preventive measures and first aid measurements regarding FBA.

PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies.

To assess the different types of management of pediatric foreign body aspirations in order to help define guidelines, depending on clinical presentation. A national survey in France was emailed to all 30 university-affiliated departments of otolaryngology-head and neck surgery and pediatric pulmonologists in France. Data concerning the center and the experience of each participant were collected in order to define an "senior expert" group with experience of extracting more than 10 foreign bodies and a "junior/non-expert" group. Both groups answered questions concerning five clinical cases of foreign body aspiration of different severities. Ninety-eight participants answered this survey (75 otolaryngologists and 23 pulmonologists), representing 28 of the 30 university-affiliated departments in France with a completion rate of 89%. Responses of the senior expert group were similar for clear-cut situations, such as an asymptomatic child with a low probability of foreign body aspiration and for a symptomatic child with respiratory distress. However, for intermediate situations, management varied significantly according to the physician when considering clinical, radiological, and surgical management. In comparison to the senior expert group, the junior non-expert group seemed more precautious in the management of foreign body aspiration for intermediate cases, in particular, concerning the time at which extraction was performed. Conclusion: The management of foreign body aspiration depends on the physician's experience and the center's habits. In order to optimize patient care for foreign body aspiration, we suggested a management algorithm based on the senior expert group responses. What is Known: •Foreign body aspirations (FBA) are dreaded by pediatricians, pediatric otolaryngologists, and pulmonologists particularly because of the potential fatal outcome. • However, consensus concerning their management is not clearly defined in the literature. What is New: •This study is the first to evaluate the management of foreign body aspirations (FBA) from the clinical assessment by the emergency medicine physician to the extraction of the foreign body. • A management algorithm was designed and secondarily validated by the SE group to help to emergency medicine physician and specialist to manage FBA.

LIMITATIONS OF RADIOGRAPHIC IMAGING IN DIAGNOSING FOREIGN ORGANIC MATTER ASPIRATION

LIMITATIONS OF RADIOGRAPHIC IMAGING IN DIAGNOSING FOREIGN ORGANIC MATTER ASPIRATION

Mancata diagnosi di ingestione di corpo estraneo

The case of an 18-month-old infant presenting with respiratory failure is described. The authors discuss the diagnostic and therapeutic management of foreign body aspiration.

Effectiveness of Video Assisted Teaching programme on knowledge regarding first aid management of foreign body aspiration among mothers of under-five children

Foreign body aspiration remains a significant cause of death in children for anatomic as well as developmental reasons. Foreign body aspiration is a potentially life-threatening event because it can block respiration by obstructing the airway, there by impairing oxygenation and ventilation. Mothers, as a primary care giver must be aware of first aid management of foreign body aspiration and measures to prevent it. Hence, the study was undertaken to assess the effectiveness of video assisted teaching programme on knowledge regarding first aid management of foreign body aspiration among mothers of under-five children in selected anganwadis under Nadathara Gramapanchayath, Thrissur. The other objectives of the study were to find out the association between level of knowledge with selected demographic variables of mothers regarding first aid management of foreign body aspiration. Quasi experimental one group pre testpost test design was conducted among 30 mothers of underfive children. Samples were selected by using purposive sampling method from 2 anganwadis. Pre test was conducted using structured knowledge questionnaire. It was followed by video assisted teaching of first aid management of foreign body aspiration with appropriate AV aids by the investigator. Post test was done after 7 days and the analysis shows that there is a significant increase in knowledge score of mothers regarding first aid management of foreign body aspiration. Also, the study findings revealed that there is no association between knowledge score of mothers with their selected demographic variables. Thus, the study concluded that the video assisted teaching regarding first aid management of foreign body aspiration was effective in improving the knowledge of mothers.

Case Report: Diagnosis and Management of Pin-Headscarf at The Bronchial Segment In RSUP Dr. M Djamil Padang

Introduction: Foreign body aspiration into the airway is a common case in children. Scarf pin aspiration often occurs in women who wear the hijab. A bronchoscopy is an option in the management of foreign body aspiration cases. However, other treatments such as thoracotomy can be considered, if the management of foreign body aspiration fails using rigid bronchoscopy. Case Report: Reported one case of a 12-year-old girl who complained of inhaling scarf pin 1 day before being admitted to hospital. Chest X-ray found radiopaque foreign body projection as high as spatium intercostal V with right lower lobe projection. The patient was diagnosed with foreign body pin scarf et right bronchus and was treated with a rigid bronchoscopy but it was not successfully extracted, one and a half months later the patient was performed Video-assisted thoracic surgery but failed to re-extract, then the foreign bodies were successfully extracted after the thoracotomy. Conclusion: Migration of pins into the bronchial segments as high as spatium intercostal V projections right lower lobe and left lower lobe will be difficult to locate and extract with rigid bronchoscopy. Thoracotomy is further management for scarf pin aspiration that fails to be treated by rigid bronchoscopy.
 Keywords: foreign body, scarf pin, bronchoscopy, segment bronchi, thoracotomy

Foreign body aspiration imitating a difficult-to-treat asthma

Tracheobronchial foreign body (FB) aspiration is an infrequent but possibly fatal event in adults. Symptoms typically consist of a choking incident followed by cough and dyspnea; however, these findings are conflicting, and symptoms may mimic other chronic pulmonary diseases such as asthma or chronic obstructive pulmonary disease. Chest radiography and computed tomography can offer information with regard to the site and features of the FB and support the diagnosis. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. A 38-year-old woman with persistent cough of 4 months’ duration, received several lines of treatment for bronchial asthma. She presented with refractory cough and chest tightness, and high-resolution computed tomography chest showed a small calcified lesion in the bronchus intermedius. Fiberoptic bronchoscopy revealed a chicken bone in the bronchus intermedius which was removed, followed by a complete recovery of symptoms and discontinuation of all asthma treatment.

Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group

BackgroundIncidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung.MethodsWe retrospectively analyzed 37 pediatric case records who presented from January 2014–December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome.ResultsAround 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non –vegetative.ConclusionUnlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.

Rigid ventilating video bronchoscope with forceps for bronchoscopic foreign body removal in children

<p>Bronchoscopic foreign body removal is a potentially dangerous and challenging procedure in pediatric surgery. bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration. A large ventilating channel and better control over the tip of the instrument and cheaper instrument are the merits of rigid bronchoscopy over flexible one. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and it is risky. Foreign body aspiration typically occurs in 6 to 18 month age and the size of glottis is very small at this age. In Indian children who are small and malnourished the large assembly of sheath and telescope mounted forceps does not pass through the glottis. To overcome the limitations of the traditional equipment I designed my own bronchoscopy equipment by my 15 year of experience in bronchoscopy. This type of device is reported for the first time in medical literature and patent is filed for it at Mumbai office.</p><p> </p>

Awareness of the first aid management of foreign body aspiration among students: A cross-sectional study.

BACKGROUND:Pediatric foreign body aspiration (FBA) is a life-threatening condition responsible for many deaths every year, especially among children younger than 2 years.OBJECTIVE:This study aimed to determine the level of knowledge among students in Jeddah, Saudi Arabia.SUBJECTS AND METHODS:This observational, cross-sectional study was conducted between December and January 2018 at Jeddah, Saudi Arabia via a paper-based questionnaire survey of male and female high school and middle school students. The Chi-square test was used to compare frequencies, and the independent t-test was used to compare means.RESULTS:A total of 671 students participated in this survey. The second item, “It is possible for a child to choke on a small toy” had the highest rate of correct responses among both males and females (93.2% vs. 94%, respectively). The eighth item “Sudden cough is a sign of choking among children” had the lowest rate of correct responses among males (40.8%) and females (33%). Most female participants (74.2%) knew that batteries are the most dangerous items a child can swallow, which requires immediate medical attention (item 14), while only 56.2% of male participants knew that (P < 0.001). The only significant predictor on linear regression analysis was “Having treated anyone with FBA” (coefficient = −0.24, P = 0.03).CONCLUSIONS:There is inadequate knowledge regarding FBA among middle and high school students, as is the case among mothers. Moreover, only a small percentage of participants had any first aid training.

Foreign body removal in children and adults: review of available techniques and emerging technologies

In adults, clinical manifestations of foreign body aspiration range from sudden onset of asphyxia and respiratory failure due to central airway obstruction to subacute and even chronic worsening of non-specific pulmonary complaints. Given a wide range of often non-specific clinical symptoms associated with foreign body aspiration, high index of suspicion is required to avoid delay in diagnosis. In this review article we describe risk factors, clinical presentation, evaluation and management of foreign body aspiration in adult and pediatric patient populations. We will review several bronchoscopic techniques for foreign body extraction and describe the use of a flexible cryoprobe and its novel application in pediatric populations to aid in foreign body removal. Finally we will highlight potential complications that may be encountered during foreign body removal.

Virtual Bronchoscopy: Highly Sensitive Time and Life Saving Investigation in the Diagnosis of Foreign Body Aspiration-Our Experience.

Foreign body airway is a common cause of morbidity and mortality in children. Virtual bronchoscopy is a new investigative technique useful in locating non radiopaque FB missed on plain radiography. The aim of the study was to study the clinical profile of patients with suspected foreign body aspiration and to evaluate the changing trends in the diagnosis and quicker management of foreign body aspiration as a way of virtual bronchoscopy. This was a retrospective and prospective cross sectional study conducted in the Department of Otorhinolaryngology M.G.M.M.C. and M.Y. Hospital Indore for a period of 10years. The medical records of patients with foreign body aspiration, from August 2006 to September 2016 were reviewed. Data was collected regarding their clinical presentation, examination and chest X-ray, virtual bronchoscopy, rigid bronchoscopy findings. Patients with suspected foreign body aspiration were subjected to virtual bronchoscopy and rigid bronchoscopy was performed. The techniques and methods to extract different types of foreign bodies has been elaborated in this study. In the 150 subjects, we observed mean age group of presentation was 2.1years, male is to female ratio was 4.1, 70% of the cases came from the rural areas, 86% were vegetative foreign bodies, and remaining non vegetative were aspirated mostly during the winter season. Betel nut was the most common aspirated foreign body 0.63% had a positive history of foreign body aspiration, where as 37% had a negative history. Right main bronchus was the most common site of lodgement. Breathlessness and reduced air entry were the most common symptoms and signs. We also observed, that chest radiograph were normal in as many as 40% cases. Hence negative chest radiographs does not rule out FB. In 150 patients with foreign body aspiration, which was detected by virtual bronchoscopy, 148 patients were diagnosed to have foreign body on rigid bronchoscopy. This amounts to a positive predictive value of 97.3% which was similar to the positive predictive value of rigid bronchoscopy which was 99%. Virtual bronchoscopy is the only imaging modality which gives 99.9% reassurance about the presence or absence of a foreign body, because of its high sensitivity and specificity, hence proves to be a life saving tool.

Rigid bronchoscopy for foreign body removal: an overview

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Foreign body aspiration is a potentially life threatening medical scenario. Immediate diagnosis and intervention can save the many adverse outcomes. The aim of our study was to determine the pattern, presentation and management of foreign body aspiration in our population. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is a retrospective study carried out in the Department of ENT and Head and Neck Surgery And Surgical Oncology, Karnataka Institute of Medical Sciences, Hubballi comprising of 22 patients with foreign body aspiration admitted to our department from July 2015 to February 2017.All patients with high suspicion of foreign body aspiration were included in our study. All patients underwent rigid bronchoscopy under general anesthesia. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study, majority of our patients were in the paediatric age group below the age of three years. History was always accidental inhalation of the foreign body. Areca nut was the most common foreign body removed. All patients who underwent successful foreign body removal following rigid bronchoscopy completely recovered from their ailments. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;It could be concluded that rigid bronchoscopy is treatment of choice in management of foreign body aspiration especially in pediatric population. The gold standard for the diagnosis and management of this condition is rigid bronchoscopy under general anaesthesia.&lt;/span&gt;&lt;/p&gt;

Foreign body aspiration in adult airways: therapeutic approach.

Tracheobronchial foreign body (FB) aspiration is an uncommon but potentially life-threatening event in adults. Symptoms typically consist of a choking event followed by cough and dyspnea, however, these findings are inconsistent and symptoms may mimic more chronic lung diseases such as asthma or chronic obstructive pulmonary disease. Chest radiography and computed tomography can provide information regarding the location and characteristics of foreign bodies and aid in diagnosis. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. The authors describe the typical clinical presentation, diagnostic evaluation, and bronchoscopic management of foreign bodies in adult airways with a focus on bronchoscopic techniques and potential complications of FB extraction.

Safely Decreasing Rigid Bronchoscopies for Foreign-Body Aspiration in Children: An Algorithm for the Emergency Department.

Rigid bronchoscopy was traditionally performed in the management of foreign-body aspiration (FBA). More recently, since development of a less invasive method, flexible bronchoscopy has been proposed in some centers for the management of FBA. For the past few years, we have applied a decisional algorithm, privileging flexible bronchoscopy for diagnosis and, in some cases, for extraction of foreign body (FB). Our aims are first to analyze our current management of FBA and second to examine the bronchoscopic findings and complications. Retrospective medical chart review of all patients with clinical suspicion of FBA who underwent bronchoscopy (flexible and/or rigid) from 2009 through 2014. An FB was found in 23 (33%) of the 70 patients included in the study (45 boys, 25 girls; median age: 21.5 months). Diagnosis of FBA was made on first intention in 22/23 (96%) and extraction was performed in 7/23 (30%) by flexible bronchoscopy. Rigid bronchoscopy was necessary for the extraction of the 16/23 (70%) remaining FBs. The rigid procedure was performed as first intention in only two (3%) patients, and one of the two was negative. Among the clinical signs of FBA, none were > 90% specific except for apnea (100%), but which was poorly sensitive (22%). Seven clinical and radiologic signs were found to be significantly different between FB+ and FB- groups: sudden choking, cyanosis, apnea, decreased breath sounds, atelectasis, mediastinal shift, and air trapping. Conversely, when none of these symptoms or signs and no clear history of sudden choking were present (in 15/70 patients), no FB was found. No life-threatening complications or death were observed. Our current management of FBA allows us to avoid almost all negative rigid bronchoscopies. In addition, we identified some symptoms and clinical and radiologic signs whose absence was highly predictive of negative bronchoscopy. We propose a novel algorithm for management of FBA that will help decrease the number of negative bronchoscopies.

Management and prevention of foreign body aspiration in children

Objective To put forward the prevention advice on foreign body suction, and to discuss the efficacy, safety and application experience of flexible bronchoscopy in the diagnosis and treatment of tracheobronchial foreign bodies in children. Methods The treatment experience of 38 cases for airway foreign body removal with flexible bronchoscopy and granulation tissue proliferation in Argon plasma coagulation(APC)(argon knife) combining carbon dioxide(CO2) cryotherapy in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command from January 2013 to December 2014 were reviewed, and the clinical data including age, gender, treatment time for inhaled foreign body, clinical and X-ray manifestations, location of the foreign body, treatment with bronchoscopy with APC and cryotherapy, complications and outcomes were analyzed. Results There were 38 cases of patients including 31 male(81.6%) and 7 female(18.4%), aged from 10 months to 14 years old, with mean age 28.5 months; among them there were 30 cases with definite history of foreign body, accounting for 78.9%; the most common clinical symptom was cough among the cases, accounting for 84.3%; X ray showed 15 cases with ipsilateral lung atelectasis, accounting for 39.5%, emphysema in 17 cases, accounting for 44.7%, pneumonia change in 6 cases, accounting for 15.8%, there were 11 cases who had lung computerized tomography examination when coming to the hospital, and only 1 case could be seen to have foreign body shadow; microscopic examination found that inhaled foreign body in the right bronchus accounted for 57.9%, and peanut was the main foreign body inhalation in this group; only 4 cases(10.5%) had definite diagnosis and foreign body removal within 24 h after foreign body aspiration, moreover, 34 cases(89.5%) with foreign body aspiration got the diagnosis and treatment after 24 h; crying was the primary inducement for inhaled foreign body.All the 38 cases of children with inhaled foreign body experienced removal under flexible bronchoscopy.There were 19 cases(50.0%) who had granulation tissue proliferation around the foreign body, among which 5 cases of foreign body was wrapped by the proliferation of granulation tissue, with APC dealing with the granulation tissue of foreign body surface to remove foreign body after exposure, then giving CO2 cryotherapy.Nevertheless, there were 9 cases of foreign body who had granulation tissue but was not wrapped, receiving CO2 cryotherapy directly after the foreign body removal.One case of this group had bradycardia during the surgery, and 2 cases had postoperative bleeding, but there was no death cases with foreign bodies removal. Conclusions Education is the key to prevent foreign body aspiration in infants under 3 years old.Flexible bronchoscopy is safe to remove foreign bodies from the respiratory tract and has fewer complications, so it is one of the alternative methods in diagnosis and treatment of foreign body inhalation. Key words: Flexible bronchoscopy; Tracheobronchial foreign body; Argon plasma coagulation; Freezing techniques; Granulation tissue; Child

Tracheostomies in the Management of Aspirated Foreign Bodies in Children at the University Hospital Center of Dakar

Objective: To share our experience in the management of foreign body inhalation in children, describing our indications for tracheostomy and making a review of literature. Design: Retrospective study. Setting: Department of ORL and Head and Neck Surgery, University Hospital Center of Dakar, Senegal Patients and Method: From 1997 to 2010, 232 children < 15 years were admitted to our ENT department with a diagnosis of aspirated foreign body, confirmed by bronchoscopy. Sixty three (63) children (population study size) underwent tracheostomies in the management of foreign body aspiration. Following data were recorded for each infant: age, sex, geographic origin, time from aspiration to hospital admission, foreign body aspiration syndrome and/or stridor, our indications of tracheostomies, endoscopic findings, decannulation delay, complications related to aspiration itself and to tracheostomy and the hospital stay. Results: Among 232 cases of aspirated foreign bodies taken care of in our ENT department, rigid bronchoscopy removed objects from the larynx in 57 cases (24.5%), the trachea in 36 cases (15.5%) and bronchus in 139 cases (60%). The most common type of foreign body was organic (146 cases, 63%) and peanuts (81 cases, 35%) were predominent. Tracheostomies were performed in 63 cases (27%). Within this group (population study), the median age was 3 years ranged from 5 months to 12 years. The male female ratio was 1.4 (37 boys and 26 girls). Median time to admission was 10 days ranged from 24 hours to 4 months. Rigid bronchoscopy had located foreign bodies in the larynx in 29 cases (46%), in the trachea in 13 cases (21%) and in the bronchus in 21 cases (33%). According to the type of foreign bodies, there were food items in 47 cases (74%) and inorganic objects in 13 cases (21%). Indications of tracheostomies were stridor for 50 cases (86%), intubation in 4 cases (6%) and laryngeal edema in 9 cases (14%). Median decannulation delay was 7 days ranged from 1 day to 2 months. Median hospital stay was 26 days ranged from 1 day to 4 months. Complications of tracheostomies like tracheal stenosis and emphysema were present respectively in one. Complications related to foreign body like bilateral pneumothorax, recurrent pneumonia and bronchitis occurred respectively in one case. Open surgical retrieval of foreign body like bronchotomy was required in 2 cases. We regretted 8 cases of death, a rate of 3.5% in relation to all foreign bodies managed in the chart. Conclusion: Foreign body aspiration is a life-threatening emergency. Early diagnosis and foreign body removal through bronchoscopy is required to avoid complications. In our conditions, tracheostomy had a critical place. We reported the highest rate of tracheostomies performed in the management of aspirated foreign bodies in the literature. The reduction of this rate could be a good mean to appreciate the improvement of management of foreign body aspiration in our countries.

Flexible bronchoscopic removal of a three piece foreign body from a child’s bronchus

Foreign body aspiration can be a life-threatening event especially in young children because they have smaller diameters of airway lumen, moreover, the delay in the diagnosis and subsequent therapeutic intervention can further increase the risk of morbidity.(1, 2) A retained foreign body can result in inflammatory response and granulation tissue formation around the object which make the foreign body removal difficult.(3) In such situations surgical intervention is usually needed but with interventional pulmonology modalities we can restrict the need for surgery.(4) Rigid bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration.(1) However, nowadays flexible bronchoscopy is more widely available and most pulmonary physicians are trained in its use so it can be used to remove such foreign bodies. We hereby report a case of a neglected foreign body which remained in the bronchus of a child for 11 days, successfully removed by flexible bronchoscopy.