Left Bronchial Foreign Body Is Always Left Rigid Bronchoscopy an Armour Beyond Barriers in Retrieval-A Case Series

Airway foreign bodies (AFBs) is an interdisciplinary area between, Pediatrics and Otolaryngology [1]. Foreign-body aspiration in the airway of children is a life-threatening clinical situation responsible for many deaths each year. Most airway foreign body aspirations occur in children younger than 15 years; children aged 1-3 years are the most susceptible [2]. Vegetable matter tends to be the most common airway foreign body; peanuts are the most common food item aspirated [5]. We present four interesting cases of bronchial foreign bodies that caused diagnostic and therapeutic challenges.

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Experiences with management of foreign body airway presenting as dire emergency

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213288 ◽

2021 ◽

Vol 7 (9) ◽

pp. 1509

Author(s):

Aishwarya Ullal ◽

Arun P. Ajith

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Case Series ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Accidental Death ◽

Detailed History ◽

Common Causes ◽

The World ◽

To Come

Aspiration of foreign bodies by children is a common problem around the world. Foreign body aspiration is a common cause of morbidity and mortality in children, especially between ages 18 months to 3 years. Laryngeal foreign bodies pose as a dire emergency lead to choking and accidental deaths. This is a case series of five cases of laryngeal foreign bodies presenting as a dire emergency to our casualty. Detailed history and examination was done. Radiological investigations were done. Rigid bronchoscopy was performed and the foreign body was extracted restoring the airway, preventing the accidental death of the patient. Foreign bodies of the airway are the most common causes of preventable deaths among children. Quick detailed history, examination and radiological investigations are required to come to the diagnosis and prompt management. This case series throws light on how to manage laryngeal foreign bodies.

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Aspirasi Benda Asing Paku dengan Komplikasi Atelektasis Paru dan Aspirasi Benda Asing Jarum Pentul Tanpa Komplikasi

Jurnal Kesehatan Andalas ◽

10.25077/jka.v4i2.311 ◽

2015 ◽

Vol 4 (2) ◽

Author(s):

Novialdi Novialdi ◽

Fachzi Fitri ◽

Histawara Subroto

Keyword(s):

Foreign Body ◽

Granulation Tissue ◽

Foreign Bodies ◽

Muslim Women ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Bronchial Foreign Body ◽

Foreign Body Extraction ◽

Sharp Foreign Body

Abstrak Aspirasi benda asing bronkus adalah masalah yang sering pada anak-anak dan merupakan masalah seriusserta bisa berakibat fatal. Sebagian besar aspirasi benda asing di bronkus pada anak-anak karena kecenderunganmemasukkan sesuatu ke mulut, pertumbuhan gigi molar yang belum lengkap, kurangnya pengawasan dari orang tuadan lain-lain. Aspirasi jarum pentul di bronkus biasanya terjadi pada wanita remaja muslim yang menggunakan jilbab.Benda asing tajam di bronkus harus segera dikeluarkan dalam kondisi dan peralatan optimal untuk mencegahkomplikasi yang timbul. Komplikasi akibat aspirasi benda asing tajam yang paling sering berupa perforasi jalan nafas,trakeitis, bronkitis, jaringan granulasi, efusi pleura dan atelektasis. Tindakan bronkoskopi merupakan pilihan untukekstraksi benda asing tajam yang teraspirasi. Dilaporkan dua kasus aspirasi benda asing tajam di bronkus yaitu padaseorang anak laki-laki, berusia 6 tahun dengan aspirasi paku dengan komplikasi atelektasis paru dan seorang anakperempuan, berusia 14 tahun dengan aspirasi jarum pentul tanpa komplikasi yang telah berhasil diekstraksimenggunakan bronkoskopi kaku.Kata kunci: benda asing tajam di bronkus, aspirasi paku, aspirasi jarum pentul, atelektasis, bronkoskopi kaku Abstract Bronchial foreign body aspiration is a common problem in children and it is a serious problem that can befatal. Most of bronchial foreign body aspiration occur in children because of the tendency to put something into themouth, the molar growth is not yet complete, the lack of supervision from parents and others situation . Aspiration of apin in the bronchi usually occurs in adolescent Muslim women who wear headscarf. Sharp foreign bodies in thebronchi must be removed immediately and the optimal equipment to prevent complications. Complications due tosharp foreign bodies aspiration most often in the form of perforation, tracheitis, bronchitis, granulation tissue, pleuraleffusion and atelectasis. Bronchoscopy is the management for aspirated sharp foreign body extraction Reported two cases of a sharp foreign body aspiration is a boy, aged 6 year old with nail aspiration complication withlung atelectasis and a girl, aged 14 year old with aspirations of a pin without complications that have been successfully extract using rigid bronchoscopy . Arial 9 italicKeywords: sharp foreign bodies in the bronchi, nail aspiration, pin aspiration, atelectasis, rigid bronchoscopy

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A comparison between Sevoflurane Volatile Induction/Maintenance Anesthesia and Propofol Total Intra-venous Anesthesia for Rigid Bronchoscopy under Spontaneous Breathing for Tracheal/Bronchial Foreign Body Removal in Children

QJM ◽

10.1093/qjmed/hcaa039.011 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

O M T Al-Safty ◽

O R Youssef ◽

D M Kamaleldin ◽

M K M Youssef

Keyword(s):

Foreign Body ◽

Controlled Trial ◽

Anesthetic Management ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Foreign Body Removal ◽

Bronchial Foreign Body ◽

Threatening Condition ◽

Life Threatening ◽

Double Blinded

Abstract Background Foreign body aspiration is a life-threatening condition. Asphyxiation from inhaled foreign bodies is a leading cause of accidental death among children younger than 4 years. While early clinicians used topical anesthesia, general anesthesia became common place for the removal of aspirated objects with increased experience with the rigid bronchoscope and advances in anesthetic delivery. Inhaled anesthesia and total intravenous anesthesia are widely used for rigid bronchoscopy in children. Objective In this study, we compared sevoflurane VIMA and propofol TIVA, when used for both induction and maintenance of anesthesia in children undergoing rigid bronchoscopy for tracheal or bronchial foreign body removal. Methods This is a prospective double – blinded, randomized controlled Trial, After Approval is obtained from the research ethics committee of anaesthesia and intensive care department, Ain Shams University. Patients were randomly divided into two groups (n = 30 each). In Group VIMA, anesthesia was induced with inhalation of sevoflurane. Before induction, a closed circuit with a 1-l reservoir bag was overflowed by 8 vol % sevoflurane with 0.3 l/min fresh oxygen flow for 3 min. In Group TIVA, a bolus of 2.5 mg/kg propofol was administered over 30 seconds. Additional propofol 0.5–1 mg/kg was given as needed to deepen anesthesia. Results Our results demonstrate that compared with propofol TIVA, sevoflurane VIMA provides more stable haemo-dynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal. Conclusion Foreign body aspiration is a life-threatening condition. Anesthetic management can be challenging, as the airway is shared with the surgeon and adequate ventilation must be maintained despite airway manipulation.

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Foreign Body Aspiration of a Dental Bridge in the Left Main Stem Bronchus

Case Reports in Medicine ◽

10.1155/2012/798163 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Monay Mahmoud ◽

Syed Imam ◽

Hetalben Patel ◽

Matthew King

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Neuromuscular Diseases ◽

Foreign Body Aspiration ◽

Main Stem Bronchus ◽

Life Threatening ◽

Left Main Stem Bronchus ◽

Successful Retrieval ◽

Prompt Diagnosis ◽

Life Threatening Event

Aspiration of tracheobronchial foreign bodies is a life-threatening event that occurs mainly in children. Occurrence in adults is rare and usually has a subtle presentation as most adults are unaware of aspiration of any foreign material. Decreased levels of consciousness, sedation, and neuromuscular diseases are major risk factors for foreign body aspiration in adults. Prompt diagnosis and intervention through foreign body retrieval are critical to prevent significant morbidity and mortality. Retrieval procedure is risky, and sudden decompensation of the patient can occur anytime. We are presenting an adult who accidentally aspirated his dental prosthesis during sleep and underwent successful retrieval of the dental bridge using flexible bronchoscopy.

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Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002837 ◽

2014 ◽

Vol 128 (12) ◽

pp. 1078-1083 ◽

Cited By ~ 15

Author(s):

G Behera ◽

N Tripathy ◽

Y K Maru ◽

R K Mundra ◽

Y Gupta ◽

...

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Multidetector Computed Tomography ◽

Diagnostic Tool ◽

Foreign Bodies ◽

Three Dimensional ◽

Tracheobronchial Tree ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Virtual Bronchoscopy

AbstractObjectives:Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.Methods:The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.Results:A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.Conclusion:Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.

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Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194925 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1552

Author(s):

Kunzes Dolma ◽

Anchal Gupta ◽

Apurab Gupta ◽

Padam Singh Jamwal

Keyword(s):

Foreign Body ◽

Clinical Examination ◽

Foreign Bodies ◽

Standard Procedure ◽

Neck Surgery ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Female Ratio ◽

Mortality And Morbidity ◽

Delay In Diagnosis

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.

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Urgent bronchoscopy for foreign body aspiration: 48 children among 1096 patients

Acta Medica ◽

10.32552/2019.actamedica.359 ◽

2019 ◽

Vol 50 (3) ◽

pp. 38-43

Author(s):

Alper Avcı ◽

Onder Ozden ◽

Zehra Hatipoglu ◽

Serdar Onat

Keyword(s):

Foreign Body ◽

Postoperative Complications ◽

Oxygen Saturation ◽

English Literature ◽

Length Of Hospital Stay ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Peripheral Oxygen Saturation ◽

Life Saving ◽

Life Threatening

Objective: Foreign body aspiration (FBA) is a potentially life-threatening emergency in children. Urgent rigid bronchoscopy (URB) should be performed when presentation includes severe respiratory failure with suspicion for FBA. To the best of the knowledge, this is the first study that evaluates URB in English literature. Methods: Forty-eight patients who underwent URB were included in this study. From the medical records, the patients’ demographic characters, endotracheal intubation status, peripheral oxygen saturation, bronchoscopy results, type and location of foreign body (FB), intra- and postoperative complications and mortality, X-ray, length of hospital stay were evaluated. Results: Twenty-four of the 48 patients were non-intubated. Peripheral oxygen saturation values were 60 ± 14.40 in the preoperative period. No statistical differences were found between intubated and non-intubated patients in terms of intra- and postoperative complications. There were no statistical differences between patients with negative and positive results for bronchoscopy in terms of intra- and postoperative complications. Conclusions: Bronchoscopy is not without risk; however, it is a life-saving procedure. Despite negative FB results, urgent bronchoscopy should be performed in suspicious cases.

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A Case of Whistle as Foreign Body in Trachea

BioScientia Medicina ◽

10.32539/bsm.v6i1.434 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1281-1286

Author(s):

Puspa Zuleika

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Pediatric Patients ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Foreign Object ◽

Case Presentation ◽

Foreign Body Extraction ◽

Tracheobronchial Foreign Body ◽

History Of

Background. Most of foreign body aspiration cases are found in children under the age of fifteen. Pediatric patients often presents with non-food foreign body aspiration, such as toys. The most common clinical manifestation are history of choking following foreign object insertion into the mouth (85%), paroxysmal cough (59%), wheezing (57%) and airway obstruction (5%). Case presentation. Main principle of airway foreign body extraction is to do it immediately in the most optimal condition with slightest possible trauma. Rigid bronchoscopy is a suitable choice for tracheal foreign body extraction. We reported a case of seven years old male with tracheal foreign body presented with history of whistle ingestion five hours prior to admission. This patient was discharged from hospital after third days of rigid bronchoscopy procedure. Conclusion. History of foreign body aspiration in children should be suspected as a tracheobronchial foreign body. Rigid bronchoscopy is preferred to extract foreign bodies present in the trachea. The prognosis for tracheobronchial foreign body aspiration is good if the foreign body is treated early and without complications.

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Foreign Bodies in the Air and Food Passages

Pediatrics in Review ◽

10.1542/pir.10.1.25 ◽

1988 ◽

Vol 10 (1) ◽

pp. 25-31

Author(s):

Margaret A. Kenna ◽

Charles D. Bluestone

Keyword(s):

Foreign Body ◽

Death Rate ◽

Foreign Bodies ◽

Foreign Body Aspiration ◽

Early 20Th Century ◽

Primary Method ◽

Foreign Body Removal ◽

Foreign Objects ◽

Bronchial Foreign Body ◽

Anesthesia Equipment

Foreign bodies of the aerodigestive tract have been recognized for centurles. Before the early 20th century, foreign body aspiration or ingestion often meant prolonged illness and death.1 Prior to the advent of modern endoscopy, bronchotomy was the primary method of laryngotracheo-bronchial foreign body removal, and blunt metallic hooks, wire nooses, esophageal forceps, and pieces of linen attached to a piece of whalebone were used to extract foreign bodies from the esophagus.2 Not surprisingly, Weist, in 1882 (as cited by Clerf2), reported a 27.4% death rate for patients undergoing bronchotomy v a 23.2% mortality for those who were not treated. In 1911, LeRoche (as cited by Clerf2) reported the use of a rigid esophagoscope for removal of sharp foreign objects. It was Chevalier Jackson, however, who developed and refined aerodigestive endoscopy. By 1936, he was able to report a decrease in mortality from foreign bodies from 24% to 2% and a 98% success rate for bronchoscopic removal.1 Although there have been marked changes in anesthesia, equipment, and endoscopic teaching since Jackson's time, his remarkable record of success has not been significantly improved upon. The mortality for all recent series is now well below 1%, mainly due to improved anesthesia, instrumentation, and medical therapy of the suppurative complications.

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Airway Foreign Bodies

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0016 ◽

2020 ◽

pp. 155-160

Author(s):

C. Anthoney Lim ◽

Rachel Whitney ◽

Jeremy M. Rose

Keyword(s):

Emergency Department ◽

Foreign Body ◽

Foreign Bodies ◽

Operative Management ◽

Treatment Modalities ◽

Foreign Body Removal ◽

Life Threatening ◽

Airway Foreign Body ◽

Emergent Airway Management ◽

Physical Findings

The presentation of an airway foreign body can range from benign to truly life-threatening. Respiratory tract obstruction from an airway or esophageal foreign body is relatively rare but remains a leading cause of morbidity and mortality among children. This chapter discusses the evaluation and management for inhaled and aspirated foreign bodies in the upper aerodigestive and lower respiratory tracts. Using anatomical areas as a systematic approach, common presentations, physical findings, and diagnostic workup including imaging options are reviewed. Treatment modalities including emergent airway management and foreign body removal are discussed, with a focus on procedures that can be performed in an emergency department setting and indications for operative management.

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