Successful Removal Of Foreign Body Research Articles

Tracheostomy-Assisted Foreign Body Removal: Insights From a Case Series and Literature Review.

Foreign body aspiration into the trachea is a common occurrence in children. While most foreign bodies in the airways can be removed using rigid tracheoscopy, there are instances where tracheostomy or tracheotomy is needed. This article presents a series of cases in which tracheostomy was necessary to remove foreign bodies, and summarizes the relevant experiences and lessons learned. We reviewed a total of 7 cases in which tracheostomy and rigid tracheoscopy were combined for foreign body removal out of a larger cohort of 1559 cases at Shenzhen Children's Hospital in Guangdong, China over a 20-year period. The combined use of tracheostomy and rigid tracheoscopy resulted in successful removal of foreign bodies in all 7 patients reviewed in this study. Six patients developed complications of tracheotomy, mainly including mediastinal emphysema (5/7), subcutaneous emphysema (3/7), and pneumothorax (1/7). Tracheotomy was temporary in all patients. In cases where a foreign body in the trachea is too large or has irregular, sharp edges, is embedded in submucosal tissues with edema, cannot be passed smoothly through the vocal cords, or local endoscopic facilities are inadequate, a tracheotomy may be necessary. However, this approach should be used with caution, and close collaboration with anesthesiologists and careful management of intraoperative emergencies are crucial for improving the success rate of the procedure. Additionally, the complications should be noted, paying particular attention to early complications such as pneumothorax, pneumomediastinum, and bleeding.

Food choking incidents in the hospital: Incidents, characteristics, effectiveness of interventions, and mortality and morbidity outcomes

AimForeign body airway obstruction (FBAO) due to food can occur wherever people eat, including in hospitals. We characterized in-hospital FBAO incidents and their outcomes. MethodsWe searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database for relevant events from 1,549 institutions. We included all patients with FBAO incidents due to food in the hospital from January 2010 to June 2021 and collected data on the characteristics, interventions, and outcomes. FBAO from non-food materials were excluded. Our primary outcomes were mortality and morbidity from FBAO incidents. ResultsWe identified 300 patients who had a FBAO incident from food. The most common age group was 80–89 years old (32.3%, n = 97/300). One-half (50.0%, n = 150/300) were witnessed events. Suction was the most common first intervention (31.3%, n = 94/300) and resulted in successful removal of foreign body in 17.0% of cases (n = 16/94). Back blows (16.0%, n = 48/300) and abdominal thrusts (8.1%, n = 24/300) were less frequently performed as the first intervention and the success rates were 10.4% (n = 5/48) and 20.8% (n = 5/24), respectively. About one‐third of the patients (31%, n = 93/300) died and 26.7% (n = 80/300) had a high potential of residual disability from these incidents. ConclusionFBAO from food in the hospital is an uncommon but life-threatening event. The majority of patients who suffered from in-hospital FBAO incidents did not receive effective interventions initially and many of them died or suffered residual disability.

AURAL SYRINGING: A ONE SIZE FITS ALL SOLUTION FOR EAR FOREIGN BODIES?

Objectives: To ascertain if aural syringing is a one size ts all solution for aural foreign body removal in a rural setting Methods: A Record based descriptive study was looked at paediatric and adult patients with Aural FB (foreign bodies) who visited ER (Emergency) and ENT-OPD (Out Patient Department) of a single institution between January 2022 and December 2022.The Diagnosis of Aural foreign bodies was based on personal history and Otoscopic ndings. Patient characteristics, foreign body type, removal attempts and complications were evaluated with respect to clinical setting and patient outcome. The Data was obtained from the records. Results: 86 patients were brought to the emergency department and ENT-OPD over a 12-month period with foreign bodies of the EAC (External Auditory Canal). Otolaryngologists used otoscope and standard metallic aural syringe as their mainstay of management. Analysis of ER and OPD cases revealed Inorganic aural foreign bodies were 65.11% and 34.88% were Organic foreign bodies. Unilateral Purulent Aural Discharge was in 46.51% (40) patients, pain in 17.44% (15), Ear Bleeding in 8.13% (7), conductive hearing loss and tinnitus was 10.46% (9) and itching in 4.65% (4). Duration of Symptoms was <1 week in 65.11% (56) cases ,1-2 weeks in 22.09% (19) and 2-4 weeks in 12.79% (11) cases. Successful removal of foreign bodies from ear by only applying aural syringing was achieved in 91.86% of cases, and usage of other methods of aural foreign body removal Forceps, Hook and Suction in 5.8% and foreign body removal under GA was 2.32% were recorded Conclusion Aural foreign bodies were commonly seen in paediatric population. Patients commonly present to the ER and OPD for removal of EAC foreign bodies. The common inorganic aural foreign bodies were cotton tip, stone and eraser whereas y, lice and bee were the organic FB. The most common symptoms and complications of aural FBs, were unilateral purulent discharge followed by pain, ear Bleeding, Tympanic membrane perforation, external meatus laceration, chronic otitis media and facial Nerve paralysis. The most common procedures used were Syringing followed by Forceps, hook and suction. It is observed that aural syringing performed by the trained hands of an otolaryngologist is a very effective method and can almost be described as a one size ts all solution for managing foreign bodies in EAC with some notable exceptions

Foreign body aspiration in children - being safe and flexible.

Anesthesia for foreign body removal in children can be quite challenging. Even though rigid bronchoscopy is considered the gold standard for foreign body removal, there is increasing evidence for successful foreign body removal using flexible bronchoscopy. This review discusses the recent implications for flexible bronchoscopy for the purpose of foreign body removal and will compare these findings to rigid bronchoscopy. During the last few years, several observational studies on foreign body removal by flexible bronchoscopy have been published, with promising results. Flexible bronchoscopy is a feasible and safe method for removing aspirated foreign bodies in children. In order to improve patient safety during the procedure, it is necessary for a pediatric anesthetist and a pediatric pulmonologist to work closely together. The anesthetist can take care of the administration of the anesthetic and maintenance of the vital functions, and the pulmonologist can carry out a safe and fast bronchoscopy. In the case of foreign body removal by flexible bronchoscopy, the anesthesiological procedure of choice should be general anesthesia with controlled ventilation via a laryngeal mask.

Laryngeal foreign body impaction: A case series

Abstract The objectives of the study were to report a case series of foreign body (FB) impaction in adult larynx and to describe their clinical presentation, diagnostic approach, and therapeutic management. This is a case series study design in a tertiary government hospital. One case had a sewing needle at the glottic level piercing the left arytenoid posteriorly and the inferior border of the epiglottis anteriorly. The second case had a fish operculum in a sagittal position located at the subglottis. And, the third case had a chicken bone in the supraglottis and airway obstruction due to a massive blood clot. Direct laryngoscopy with successful removal of FBs was performed under general anesthesia or intravenous (IV) sedation. Plain radiographs are the ideal initial diagnostic imaging in these cases but there is a possibility of false negative of 47%, and thus, CT scan is recommended for meat bone with a higher specificity rate of 45% in stable patients with protracted duration of symptoms. Emergency FB extraction is warranted in these cases to prevent airway trauma, massive bleeding, and laryngoedema, but the anesthetic and surgical approach is still a case-to-case basis depending on the size, location, nature of FB, and status of the patient.

Successful Surgical Removal of a Perforating Ventricular Foreign Body from a Mallard Duck (Anas platyrhynchos): A Case Report

Swallowing foreign bodies is an important cause of emergency visits in pet birds. An adult female mallard duck with a history of anorexia, weakness, and depression was referred to the Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran. Radiographic examination showed the penetration of a needle in the ventriculus (gizzard). Since foreign bodies can lead to obstruction and injury that is life-threatening, the team's decision was surgical removal by ventriculotomy under general anesthesia. The patient was laid in dorsal recumbency on a heating pad, and the feathers around the incision site were removed. Then a skin incision was made in the middle of the abdomen. The ventriculus was explored, and the infiltrated foreign object was carefully removed. To the best of the authors’ knowledge, this study reports the first successful foreign body removal surgery in a duck in Iran. During the 10-day follow-up period, no complications were observed, and the duck was healthy. Prompt intervention and surgical treatment might be necessary to remove penetrating gastrointestinal foreign bodies located in the gizzard of domestic ducks.

When bronchoscopy does not suffice for airway foreign body removal: a series of cases requiring tracheotomy.

To illustrate the importance of tracheotomy in difficult cases of foreign body inhalation and to enumerate the indications of the same. A retrospective analysis of 5 cases in which the standard rigid bronchoscopic approach had to be combined with the open surgical approach (tracheotomy) for the removal of the inhaled foreign body for different indications. Combining the two procedures lead to successful removal of foreign body and restoration of airway in all the cases. Tracheostomies whenever performed were temporary. Foreign body aspiration is an otorhinolaryngologic emergency that can rapidly prove fatal if not well-handled. Though most cases can be dealt with by traditional approaches, a proportion of the cases may prove challenging and need a quick tailoring of response according to the situation at hand. An approach combining tracheotomy with the traditional bronchoscopic approach is one such way and in well-selected cases, can have a significant impact on the outcome; sometimes even in terms of life and death.

"Into the fire" approach to teaching endoscopic foreign body removal using a modular simulation curriculum.

As flexible endoscopy becomes an increasingly valuable minimally invasive approach to surgical challenges, an efficient and comprehensive training curriculum is needed to train surgeons in therapeutic endoscopy. We developed a modular curriculum utilizing a simulation-based, "into the fire" approach to endoscopic foreign body removal for practicing physicians with task performance pre- and post-testing. From 2020 to 2021, two sessions of our advanced flexible endoscopy course were taught by two expert surgical endoscopists using ex-vivo porcine models. The course focused on safe removal techniques for various foreign bodies as part of an overall endoscopy curriculum that uses hands-on simulation-based pre-testing, didactics, and mentored practice sessions, followed by post-course examination. Pre- and post-course assessments and surveys were used to evaluate knowledge, performance, and confidence of participants, and subsequently analyzed using the Wilcoxon-signed rank test. Of the 16 practicing physicians who participated in the course, 43.8% were certified in Fundamentals of Endoscopic Surgery, and 62.5% had completed > 200 prior upper endoscopies. Upon course completion, scoring on knowledge-based written examinations improved from 3.4 ± 1.9 to 5.8 ± 2.0 (p < 0.001). Technical facility of each participant demonstrated significant overall improvement with post-course score increased from 15.8 ± 2.5 to 23.6 ± 1.6 (p < 0.001), with skill refinement noted in technical subcategories of appropriate instrument use (p < 0.001), foreign body manipulation (p < 0.001), and successful foreign body removal (p < 0.001). Confidence surveys likewise demonstrated significant increase in confidence after completion of the curriculum 11.6 ± 3.4 to 23.0 ± 5.5 (p < 0.001). The "into the fire" approach to teaching endoscopic foreign body removal utilizing our simulation module provides an effective curriculum to improve knowledge, confidence, and overall technical performance. Our methodology utilizes hands-on, simulation-based pre-testing prior to instruction. This introduces clinical scenarios and technical challenges, while accounting for and tailoring to provider-specific variation in knowledge and experience, facilitating training efficiency.

Fogarty Catheter

Introduction:The extraction of smooth spherical objects is challenging as they are difficult to grasp within the jaws of the forceps and tend to slip distally.Objective:The authors herein have shared their experience with the use of a Fogarty catheter (FC) for safe extraction of smooth and spherical “foreign body (FB) with a hole.”Materials and Methods:Report on pediatric cases (n = 4) of airway “FB with a hole” wherein the FC was used for their extraction. Mean age was 27.5 months (range: 17 months–39 months). The male: female ratio was 3:1. The technique of FB extraction with a FC has been described, including the principle of the technique, indications, and contra-indications, technical problems and troubleshooting.Results:The FB spectrum included a necklace bead (n = 2), nonnecklace bead (n = 1) and a fragmented end-piece of the housing of a ball-pen (n = 1). The locations of the FBs were right main bronchus (n = 1), secondary bronchus on the right (n = 1), and in the left main bronchus (n = 2). Successful removal of FB with use of FC during rigid broncoscopy was possible. The bead had to be rotated in n = 2 patients to align the hole with the FC. Problems associated with threading the hole and disimpaction of the FB have been highlighted. No complications were observed. The advantages and limitation of the technique have been discussed.Conclusions:The use of FC with the described technique offers a safe, effective and reproducible method for removal of airway “FB with a hole” in a controlled environment while minimizing the possibility of iatrogenic injury to the wall of the surrounding airways.

1485 Rectal Foreign Body: A Novel Minimally Invasive Extraction Technique With Blakemore Tube

INTRODUCTION: Rectal foreign bodies often pose a challenging diagnostic and management. They are usually classified as sharp or blunt and sexual or non-sexual. A few novel techniques described in literature to aid with extraction include Foley catheter, Blakemore tube, obstetrical forceps and vacuum extractor. We describe such a case of rectal foreign body extraction with Blakemore tube and flexible sigmoidoscopy, which saved the patient from an open surgical approach. CASE DESCRIPTION/METHODS: A middle-aged male presented to the Emergency room with complaint of inability to pass a rectal foreign body (cucumber) he had inserted into his rectum. He reported doing this on a regular basis and would usually remove them by bearing down. He did endorse any vomiting or abdominal pain and had been passing gas. A CT scan noted an elongated 23.5 × 4.9 × 4.7 cm foreign body in the rectosigmoid area with no bowel wall thickening or perforation with distal tip was 8.8 cm from the anal verge. Initial attempts at manual extraction by surgeon with exam under anesthesia were unsuccessful. An adult upper endoscope was inserted and used to guide a Blakemore tube under direct visualization beyond the proximal edge of the foreign body. The gastric balloon was inflated to 60 cc with saline and endoscope was withdrawn. Traction was applied by pulling the Blakemore and distal edge of cucumber was manually grasped and removed by the surgeon. Endoscopic re-inspection of the rectosigmoid colon confirmed no deep mucosal injury. DISCUSSION: This case demonstrates a few important principals which one should be cognizant of when managing large rectal foreign bodies. The most important factor in successful extraction is patient relaxation. Objects located more proximally in the rectum or the distal sigmoid colon may need a combined approach between gastroenterology and general surgery. A combined approach is also safer and minimally invasive, and able to save patient from an unneeded laparotomy. It is also important to re-evaluate the bowel mucosa for inadvertent injuries and perforations after successful removal of foreign body.

Foreign Body Rectum- A Case Report

Rectal foreign bodies are confronted frequently in a surgical emergency. These are often related to sexual behaviour. Due to the fear of social embarrassment, patients tend to hide the facts associated with the incident and present late. Because of the serious complications, foreign body rectum should be considered as an emergency and managed in a well-organised manner. Diagnosis can be made by clinical and radiological examination. In the majority of cases, the transanal approach is successful. Laparotomy is reserved for cases with perforation or peritonitis. Here, we report the case of a 24-year-old male who inserted an electrical beard trimmer in his rectum under alcohol intoxication. Since transanal removal failed, emergency laparotomy with successful removal of foreign body was done.

Efficacy of intravenous administration of apomorphine for removal of gastric foreign material in dogs: 495 cases (2010–2015)

To evaluate the efficacy of IV administration of apomorphine for removal of gastric foreign bodies in dogs. 495 dogs with gastric foreign bodies. Records of a veterinary hospital were searched to identify dogs that received an injectable formulation of apomorphine between January 1, 2010, and July 30, 2015. Dogs with a gastric foreign body that received an IV injection of apomorphine were included in the study. Information extracted from the record of each dog included signalment, type of foreign material ingested, duration between foreign material ingestion and emesis, dose and number of doses of apomorphine administered, and whether emesis occurred and did or did not result in successful removal of the foreign body. Descriptive data were compared between dogs with and without successful foreign body removal. Emesis with successful foreign body removal was achieved in 363 and 11 dogs after administration of 1 and 2 doses of apomorphine, respectively. Successful removal was more likely for young dogs and dogs that had ingested fabric, leather, or bathroom waste. Successful removal was less likely as the duration between foreign body ingestion and emesis increased and for dogs that received opioids, sedatives, or antiemetics before apomorphine administration. Minor adverse effects were recorded for only 4 dogs. IV administration of apomorphine was a viable alternative for induction of emesis and removal of gastric foreign bodies in dogs. Dogs should be examined as soon as possible after foreign body ingestion and should not receive any medications that might affect apomorphine efficacy.

Inhaled Foreign Body Impaction: A Review of Literature in Malaysian Children.

Foreign body aspiration in children is a problem that can lead to several complications, including death. In this retrospective publication review from 1970 to 2015, there were altogether 42 Malaysian children below the ageof 15 y reported with foreign body (FB) ingestion. There were 31 boys and 11 girls between 2 and 177 mo of age. The incidence of FB ingestion in children varied with dietary practices. Peanut was the most common food-related substance inhaled followed by watermelon seed and coconut kernel. The most common non-food related substances were metal objects (toys, springs, hair clips) and plastic objects (ballpoint tips, pencil capsand whistles). Successful removal of FB by bronchoscopy is achieved in the vast majority of cases except for a case of impacted whistle inhalation and a neglected laryngeal FB which required a tracheostomy. One child required thoracotomy for the removal of a peanut in the right bronchus. The incidence of food-related substance inhalation was more common than non-food related substance (30:7). From this review, the key messages are two: first, prevention can be achieved by educating parents not to allow access to small objects or dangerous foods to children below 3y age; Second, emergency first aid home measures, in the combination form of back blows in the head down position and chest or abdominal thrusts, should be early performed according to the pediatric age group and can be quite effective.

Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Single-Centre Experience

Introduction: Foreign body ingestion is a relatively common clinical problem. We report our clinical experiences in endoscopic management of upper gastrointestinal foreign bodies by endoscopy in a centre of northern Bangladesh. Methods: This retrospective study was conducted at Shaheed Ziaur Rahman College and Hospital, Bogura, Bangladesh, over a 2-year period. Patient characteristics, endoscopic findings, type of foreign body and its anatomical location, treatments and outcomes were analyzed. Results: We included 51 patients with foreign bodies in upper gastrointestinal tract. Most of them were found in esophagus (94.12%) predominately in lower esophagus (47.92%). Dysphagia (35.29%) and foreign body sensation (27.45%) were the most common complaints of foreign bodies impaction. Meat bolus (47.06%) and coins (29.41%) were the most common type of foreign bodies in adults and children, respectively. Patients were mostly affected (21.56%) during period of Eid -al - Adha (Islamic festival of sacrifice). Endoscopic foreign body removal was successful in 98.04% of cases, whereas surgery was required in only 1 patient. The most frequently used endoscopic accessory devices were retrieval forceps (38%) and Dormia basket (38%). Associated pathology were reported in 12 (24.53%) patients. Conclusion: Our experiences with foreign bodies impaction emphasize the importance of endoscopic approach and removal is simple and safe when performed by skilled hands. So, endoscopic interventions can increase the chance of successful removal of foreign bodies and reduction of the need of surgery.

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;

Role of Point of Care Ultrasound in the Diagnosis of Thigh Foreign Body and Its Removal

Accidental punctured injuries may result in foreign body retention. Correct diagnosis, prompt localization and early removal may prevent complications and infections. The diagnosis is usually made by radiography for radiopaque foreign body. In addition to detection, point of care ultrasound can assist foreign body localization and removal. We report a case presenting with left thigh punctured nail and ultrasound is used to detect, localize and remove the nail. Case report and literature review. A 49 year old man accidentally injured by the nail gun during work and presented with left thigh punctured wound and a retained nail. The radiography confirmed the nail in the left thigh. We used ultrasound to detect the retained nail and found the majority of the nail was located within subcutaneous tissue and only a small portion of the nail was punctured into the muscle. Under ultrasound guidance, we used syringe needles to approach the nail in both ends and removed the 4.5 cm nail successfully at bedside with small incision in the emergency Department. This case indicates that point of care ultrasound is useful for foreign body detection, localization and removal. High resolution linear transducer and skilled needling technique are the mainstays for successful foreign body removal.

Foreign Body Aspiration in the Elderly Patient

The aspiration of foreign bodies is more common in the extremes of age. The increased risk in the elderly patient results from multiple factors including poor dentition, altered sensorium, poor coordination of deglutition mechanisms, and significant comorbidities. Unfortunately, non-specific symptoms contributing to a delay in diagnosis often result in complicated management issues. We describe the epidemiology, clinical presentation, and treatment options in the elderly patient. A high index of suspicion and prompt multidisciplinary approach maximize the likelihood of a positive outcome. An assessment of the technological and human capital necessary to address this life-threatening condition will likely guide the decision to treat or transfer the patient to the appropriate facility. Flexible and rigid bronchoscopies are the cornerstones of the diagnosis and treatment and should always be offered to the patient, regardless of the overall clinical condition. The probability of successful foreign body removal in trained hands is very high.

Clinical Outcome of Negative Rigid Esophagoscopy in Patients with Suspected Foreign Body Ingestion

Objectives: Identify the reasons and clinical outcome for negative rigid esophagoscopy (NRE) in patients with suspected foreign body (FB) ingestion. Methods: A retrospective chart review was performed on patients with a history of FB ingestion with negative rigid esophagoscopy over a 12-year period. Patients with suspected FB ingestion underwent rigid esophagoscopy (RE) when they were symptomatic and/or when the radiological investigations revealed suspicious feature(s) of an FB. NRE patients were categorized as 1) passed out FB; 2) false positive indications for RE; or 3) migrated FB. Clinical outcomes were evaluated based on successful FB removal and complications following either FB ingestion or treatment related interventions. Results: 89 (12.3%) out of 723 patients who underwent rigid esophagoscopy for suspected FB ingestion had NRE. 61.8% (55/89) had spontaneous FB passage without any complications; 36.0% (32/89) had a false positive indication for RE; and 2.2% (2/89) had migrated FB necessitating neck exploration with successful removal of the offending FB. Abnormal calcifications seen on radiological investigation accounts for 34.4% of these patients having false positive indications for RE, with 2 patients having thoracic exploration to rule out a migrated thoracic esophageal FB. Conclusions: The prevalence of NRE in patients with suspected FB is low (12.3%). However, 36.0% of patients had rigid esophagoscopy performed due to false positive indication, and nearly a third of these patients were primarily due to abnormal calcifications seen on the radiological investigations.

Removal of foreign bodies from children’s ears: a nurse-led clinic

This article presents an account of the rationale for and the introduction of a change in practice. The successful removal of foreign bodies from children's ears requires appropriate skills and experience. While traditionally a role for junior doctors, removal of foreign bodies from children's ears at the ear, nose and throat outpatient clinic at Birmingham Children's Hospital was associated with a low success rate. Therefore, it was proposed that an experienced advanced nurse practitioner would carry out this task in an attempt to improve patient outcomes. A database of outcomes was maintained and compared with those from a doctor-led clinic at Nottingham University Hospitals NHS Trust. The results highlight the benefits of nurse-led removal of foreign bodies from children's ears.

“Stuck”: Removal of Embedded Distal Airway Foreign Bodies

Objective: 1) Describe a novel technique for removal of embedded distal airway foreign bodies. 2) Apply the proximal endoscopic balloon dilation technique for removal of embedded distal airway foreign bodies in 2 patients. 3) Discuss the evolution, operative considerations, and future applications of the technique Method: Report of 2 cases in 2011. Condition studied: Embedded, symptomatic distal airway foreign bodies. Subjects studied: Pediatric airway patients. Setting: Tertiary care pediatric hospital. Intervention: Rigid bronchoscopy with endoscopic balloon dilation of the proximal bronchial segment to facilitate access to the foreign body. Outcomes: Successful foreign body removal. Results: Case 1: A 23-month-old patient with recurrent pneumonia. Rigid bronchoscopy showed a cashew piece in the distal airway with proximal edema preventing removal. Dilation of the proximal bronchial segment with a Fogarty catheter allowed for access and removal with optical forceps. Case 2: Two-year-old unrestrained passenger in a motor vehicle accident with tooth aspiration causing intermittent respiratory distress. At bronchoscopy, the tooth was in the distal airway and embedded in granulation tissue which prevented removal. A Fogarty catheter was used to dilate the bronchial segment proximal to the foreign body which was then removed with optical forceps. Conclusion: Embedded airway foreign bodies are associated with edema and granulation tissue which may prevent removal due to proximal airway narrowing. We present a novel technique using a Fogarty balloon catheter to dilate the airway proximal to the foreign body. This allows for removal of otherwise stuck distal airway foreign bodies.