Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy
Keywords:Bronchus, Foreign body, Inhalation
Background: The foreign body aspiration is one of the commonest ENT emergencies. Delay in diagnosis and treatment may lead to significant morbidity and mortality.
Methods: The current study was conducted at Department of Otorhinolaryngology and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, from November 2017 to October 2018. All symptomatic patients diagnosed with foreign body aspiration on the basis of history, clinical examination and radiological evaluation and who underwent rigid bronchoscopic retrieval were included in the study. Fifty patients were studied.
Results: The majority of patients 33 (66%) were between 1 and 3 years of age.12 (24%) patients were over 3 years of age with oldest of 57 years old age with male: female ratio of 2.1:1. The clinical features of these patients were mainly cough, respiratory distress, wheeze, fever, stridor, choking and cyanosis. On bronchoscopy, foreign body was identified in 46 (92%) patients and no foreign body was seen in 4 (8%) patients with suspected foreign body aspiration. The most common type of foreign body was organic (73.91%), with peanuts (47.82%) being the commonest. The most common site was left bronchus seen in 22 (47.83%) patients followed by right bronchus seen in 18 (39.13%) and trachea seen in 6 (13.04%) patients. Overall mortality and morbidity rates were 2.17% and 4.35% respectively.
Conclusions: History and clinical examination should be more relied upon as diagnostic tool than radiological findings in diagnosing foreign body inhalation. Rigid bronchoscopic removal of foreign body is the standard procedure for removing tracheobronchial foreign bodies.
Cataneo AJM, Cataneo DC, Ruiz RL Jr. Management of tracheobronchial foreign body in children. Pediatr Surg Int. 2008;24(2):151-6.
Limper AH, Prakash UBS. Tracheobronchial foreign bodies in adults. Ann Intern Med. 1990;112:604-9.
Black RE, Choi KJ, Syme WC. Bronchoscopic removal of aspirated foreign bodies in children. Am J Surg. 1994;148(6):778-81.
Tucket P, Cervin A. Reducing the number of rigid bronchoscopies performed in suspected foreign body aspiration cases via the use of chest computed tomography: is it safe? A literature review. J Laryngol Otol. 2015;129:S1-S7.
Salih AM, Alfaki M, Alam Elhuda DM. Airway foreign bodies: A critical review for a common emergency. World J Emerg Med. 2016;7:5-12.
Bodart E, Gilbert A, Thimmesch M. Removal of an unusual brochial foreign body: Rigid or flexible bronchoscopy? Acta Clinica Belgica. 2014;69(2):125-6.
Hoeve L, Rombout J, Pot D. Foreign body aspiration in children. The diagnostic value of signs, symptoms and preoperative examination. Clin Otolaryngol. 1993;18:55-7.
Jackson C. Bronchial obstruction. Dis Chest. 1950;17:125-50.
Gang W, Zhengxia P, Hongbo L. Diagnosis and treatment of tracheobronchial foreign bodies in 1024 children. J Pediatr Surg. 2012;47:2004-10.
Ayogdan LB, Tuncer U, Soylu L. Rigid bronchoscopy for the suspicion of foreign body in the airway. Int J Pediatr Otorhinolaryngol. 2006;70(5):823-8.
Kim IG, Brumitt WM, Humphrey A. Foreign body in the airway a review of 202 cases. Laryngoscope. 1973;83:347-52.
Zarella JT, Dimler M, McGill LC. Foreign body aspiration in children: value of radiography and complications of bronchoscopy. J Pediatr Surg. 1998;33:1651-4.
Sinha V, Memon R, Gupta D. Foreign body in tracheobronchial tree. Indian J Otolaryngol Head Neck Surg. 2007;59(3):211-4.
Ciftci AO, Bingol-Kologlu M, Senocak ME. Bronchoscopy for evaluation of foreign body aspiration in children. J Pediatr Surg. 2003;38(8):1170-6.
Tan HKK, Brown K, McGill T. Airway foreign bodies (FB): a 10 year review. Int J pediatr Otorhinolaryngol. 2000;56:91-9.
Safari M, Manesh MR. Demographic and clinical findings in children undergoing bronchoscopy for foreign body aspiration. Ochsner J. 2016;16(2):120-4.
Chung MK, Jeong HS, Ahn KM. Pulmonary recovery after rigid bronchoscopic removal of airway foreign body. Laryngoscope. 2007;117(2):303-37.
Fazal I, Nimatullah H. Rigid bronchoscopy for extraction of foreign bodies tracheobronchial tree: An experience of 232 cases. JPMI. 2011;25:152-7.
Muhammad A, Shahid A, Farida K. Analysis of tracheobronchial foreign bodies with respect to age, sex, type and presentation. J Ayub Med Coll Abbottabad. 2007;19:13-5.
Tomaske M, Gerber AC, Weiss M. Anaesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal. Pediatr Anaesth. 2006;16(2):123-9.
Kaur K, Sonkhya N, Bapna AS. Foreign bodies in the tracheobronchial tree: A prospective study of 50 cases. Indian J Otolaryngol Head Neck Surg. 2002;54(2):30-4.
Fidkowski CW, Zheng H, Firth PG. The anesthetic considerations of tracheobronchial foreign bodies in children: A literature review of 12,979 cases. Anesth Analg. 2010;111:1016-25.