Aspiração de corpo estranho por menores de 15 anos: experiência de um centro de referência do Brasil

Abstract

Objective: To describe the clinical, radiological and endoscopic characteristics of foreign body aspiration among individuals under the age of 15 treated at a referral center in the city of São Luís, Brazil. Methods: This was a descriptive study using data from the medical charts of patients treated for foreign body aspiration at the Hospital Universitário Materno Infantil between 1995 and 2005. We investigated 72 confirmed cases of foreign body aspiration, evaluating the place of residence, as well as biological, clinical, radiological and endoscopic variables. We used the chi-square test to identify statistically significant differences in frequency among the variables studied. Results: The majority of the patients were from outlying areas (55.6%). The following variables presented the highest frequencies: 0-3 year age bracket (81.9%); male gender (63.9%); evolution > 24 h (66.7%); hypotransparency on chest X-ray (57.7%); foreign body in the right lung (41.2%) or in the larynx (20.5%); organic nature of the foreign body (83.3%); complication in the form of localized inflammation (59.4%); glottal edema as an endoscopic complication (47.6%); and seeds (46.6%), fish bone (28.3%) or plastics (25.5%) as the type of foreign body. There were no deaths. Conclusions: Preventive care should be a priority for male children under the age of 3 living in outlying areas. Such children should not be given access to substances that can be aspirated, including certain foodstuffs. Simple and easily accessible radiological tests have been underused, which jeopardizes the quality of the initial treatment.Keywords: Foreign bodies; Inhalation; Bronchoscopy. ResumoObjetivo: Descrever as características clínicas, radiológicas e endoscópicas da aspiração de corpo estranho por menores de 15 anos em um centro de referência em São Luís, MA. Métodos: Estudo descritivo realizado a partir de dados de prontuários dos pacientes atendidos no Hospital Universitário Materno Infantil devido à aspiração de corpo estranho entre 1995 e 2005. Avaliamos 72 casos confirmados de aspiração de corpo estranho em relação à procedência, variáveis biológicas, clínico-radiológicas e endoscópicas. Para verificar se as frequências observadas das variáveis em estudo foram estatisticamente significantes, utilizamos o teste do qui-quadrado. Resultados: A maioria do pacientes era procedente das cidades do interior (55,6%). As maiores frequências das diferentes variá-veis estudadas foram as seguintes: faixa etária de 0-3 anos (81,9%); sexo masculino (63,9%); tempo de evolução > 24 h (66,7%); hipotransparência na radiografia de tórax (57,7%); localização do corpo estranho no pulmão direito (41,2%) ou na laringe (20.5%); natureza orgânica do corpo estranho (83,3%); complicação como processo inflamatório localizado (59,4%); edema de glote como complicação do exame endoscópico (47,6%); e sementes (46,6%), espinha de peixe (28,3%) e plásticos (25,5%) como tipos mais frequentes de corpos estranhos aspirados. Não houve óbitos. Conclusões: Cuidados preventivos devem p...

Perfil dos acidentes na infância e adolescência atendidos em um hospital público

“…These data are similar to those found in a study in the municipality of São Luís (MA); predominance is 81.9% in the age range of 1 to 3 years. (12) Animal bites occurred mainly among males (77.7%) and in the age range of 5 to 9 years (38.8%). This occurrence can be explained by the fact that boys may more frequently be permitted greater liberty and often engage in more hostile games with animals, in addition to a lack of perception of risk and lack of knowledge of aggressiveness of the animal.…”

Preliminary experience in the management of tracheobronchial foreign bodies in lagos, Nigeria

“…There was also a propensity to mainly involve male children with most series showing 60-70% male predilection [1, 3, 4, 13, 14, 15, 16]. This is due to a combination of their natural curiosity, placing of various objects in the mouth and the small calibre of the airway which increases the risk of impaction [13, 14, 17]. The average age in our series was older at 6.6 ± 5 years and there was an equal male to female ratio.…”

“…Another possibility is that organic materials are known to cause a severe type of chemical bronchitis and materials like peanuts and beans swell causing obstruction of the distal bronchi. Patients with inorganic TFB show less respiratory compromise and are therefore more likely to present as referrals to a tertiary centre [17]. As most patients in this series had a delayed presentation, those with organic TFB may have succumbed to a higher mortality in the community.…”

“…Bronchoscopic extraction of foreign bodies should however be performed with surgical backup as surgical intervention may occasionally be necessary for the extraction procedure as seen in the patient who required a tracheotomy to achieve foreign body extraction. It is advisable to proceed to surgical extraction if bronchoscopic extraction fails [12, 17]. …”

“…The team needs to recognize when efforts to retrieve the foreign body are causing excessive mucosal irritation and may lead to a compromised airway [9, 10, 13, 14, 17]. Airway compromise may have combined with migration of the foreign body in 7th patient in the series with the resultant mortality.…”