Complicated Paediatric Bronchial Foreign Body: A Novel Extraction Technique

A paediatric bronchoscopy procedure for foreign body inhalation is indeed a highly challenging procedure due to multiple risk factors such as lower physiological functional residual capacity and adverse pulmonary function effects by anaesthetic agents in addition to concurrent active lungs infection. Here we elucidate a novel technique of foreign body removal located at the distal airway in a paediatric patient and in a situation where a paediatric flexible bronchoscopy with built-in working channel is not available. A 1-year 7-months-old boy presented with acute respiratory distress syndrome following a one-week history of active respiratory infection. On examination, he was tachypnoeic with audible soft inspiratory stridor and intermittent barking cough despite being supplemented with 3 liters /minute oxygen mask. Chest x-ray showed right upper lobe collapse. He was referred to the otorhinolaryngology team after a suspicious history of foreign body aspiration obtained from his mother. Bedside flexible nasopharyngolaryngoscopy showed granulation tissue at the junction of laryngeal surface of epiglottis and anterior commissure. He underwent emergency direct laryngoscopy, tracheoscopy, bronchoscopy, excision of granulation tissue and removal of foreign body under general anaesthesia. Herein, some of complicated bronchoscopy demand critical thinking of alternative or modified techniques to achieve a successful and safe surgery. Bangladesh J Otorhinolaryngol 2021; 27(2): 177-183

Missed foreign body inhalation for 15-years

Background: Foreign body inhalation is a life threating event in children and it is common in our country ,which is a daily practice of Thoracic .It can lead to morbidity even mortality in the hands of untrained or not well- trained doctors. Aim: Is to report a case of missed foreign body inhaled 15-years back, which is uncommonly reported in the literatures and to compare it with other studies reporting similar cases. Methods: The details, presentation, clinical findings, radiological appearance and the successful removal by a rigid bronchoscope under general anesthesia will be presented. Results: The successful removal of this long standing impacted foreign body (plastic whistle) using the rigid bronchoscope and the eventful outcome of patient’s clinical symptoms is elucidated. Conclusion: Refractory respiratory symptoms of long duration without improvement justify the need for diagnostic bronchoscopy which will offers the best chance of cure in missed foreign body inhalation.

Comprehensive Analysis of the Diagnosis and Treatment of Tracheobronchial Foreign Bodies in Children

Objective: To analyze the factors influencing the diagnosis and treatment of tracheobronchial foreign bodies (TFBs) in children. Methods: The clinical data of 300 consecutive children with suspected TFBs who were admitted to our department between January 2016 and December 2019 were retrospectively collected, including demographics, diagnosis, history of foreign body inhalation, preoperative chest computed tomography (CT) findings, duration of foreign body retention, time from admission to operation, operation duration, duration of hospitalization, and complications. Results: Among the 300 cases, the male:female ratio was 193:107, and the age range was 6 months to 12 years (median age: 19 months). A total of 291 cases (97.0%) involved TFBs confirmed by rigid bronchoscopy, while the other 9 cases (3.0%) involved bronchopneumonia. The diagnostic accuracy, sensitivity, and specificity of a history of foreign body inhalation and chest CT were 96.0%, 98.6%, and 11.1% and 97.7%, 97.6%, and 100%, respectively. The duration of hospitalization, time from admission to operation, and operation duration were all related to bronchopneumonia ( P < .05). Conclusions: A detailed history, adequate physical examination, and preoperative imaging examination help improve the diagnostic accuracy. Preoperative bronchopneumonia in children with TFBs will increase the surgical risks and treatment costs, prolonging the duration of hospitalization.

Common Radiological Findings in Children with Suspected Foreign Body Inhalation

BACKGROUND: Foreign body inhalation is an emergency situation, affecting children mostly in first decade of life. An aspirated solid or semisolid object may lodge in the larynx or trachea may cause complete obstruction. Lesser degrees of obstruction or passage of the obstructive object beyond the carina can result in less severe signs and symptoms. Chronic debilitating symptoms with recurrent infections might occur with delayed extraction, or the patient may remain asymptomatic. Many aspirated foreign bodies are unexpectedly discovered, go undetected, or are misdiagnosed. In many cases with suspected foreign body radiological findings may reveal other findings e.g. emphysema, atelectasis, air trapping. OBJECTIVE: To determine the frequency of common radiological findings among children with suspected foreign body inhalation. MATERIAL AND METHODS: This cross-sectional descriptive study was conducted at Department of ENT, Khyber Teaching Hospital, Peshawar, from April 2017 to October 2017. In this study a total of 141 patients were observed. All patients were subjected to detailed history and clinical examination. X ray chest (AP and lateral views) of all the patients was performed to detect common radiological findings (Radio-opaque Foreign Body (FB), Pneumonia, Emphysema, atelectasis and Air Trapping). The demographic details like name, age, gender, address and contacts were recorded on a pre-designed proforma. RESULTS: In this study mean age was 8 years with SD ± 3.563. Sixty percent children were male while 40% children were female. Sixteen percent children had Radio opaque FB, 13% children had pneumonia, 28% had emphysema, 18% children had atelectasis while 25% had Air trapping. CONCLUSION: Our study concludes that the frequency of Radio opaque was 16%, pneumonia 13%, emphysema 28%, atelectasis 18%, Air trapping 25% among children with suspected foreign body inhalation. KEY WORDS: radiological findings, suspected foreign body inhalation, Pneumonia, Emphysema, atelectasis and Air Trapping