A simple management option for chronically impacted sharp tracheobronchial foreign bodies in children

Abstract

Distally impacted chronic tracheobronchial sharp foreign bodies in children are a management challenge that presents with clinical subtlety and extreme variability. The use of image guided techniques, imaginative instrumentation, tracheotomy, thoracotomy, and even extracorporeal membrane oxygneation have been reported. Endoscopy is made difficult by the distal location, inflammatory reaction with granulation tissue formation, and bleeding obscuring the foreign body. Our aim is to describe our experience with two children who had removal of aspirated impacted sharp metallic foreign bodies from the distal airway using rigid bronchoscopy, preceded by maximal medical therapy.

Risk factors for lower respiratory tract infection in children with tracheobronchial foreign body aspiration

“…The key to the diagnosis of this disease lies in the history of foreign body inhalation. [ 25 , 26 ] Preoperative assessment of a child's physical condition and severity of illness is critical for surgery. [ 20 ] Furthermore, preventing children from crying can reduce the chance of foreign bodies moving, causing sudden death from asphyxiation.…”

Broncoaspiração de corpo estranho com retirada por toracotomia: relato de caso e revisão de literatura

“…Um outro artigo resgatado propõe o que caracteriza como "medida simples" para o manejo de CE traqueobrônquicos afiados e cronicamente impactados, uma vez que objetos de longa permanência promovem significativo edema e granulação tecidual nas vias aéreas, tornando sua extração por via endoscópica não só um desafio, mas uma impossibilidade, ampliando os riscos de procedimento cirúrgico aberto. A sugestão é a administração de antibiótico e corticoide intravenoso e via nebulização durante 48 a 72 horas antes do procedimento broncoscópico, objetivando a redução do processo inflamatório, proporcionando visualização e manipulação adequadas do CE (15) . Dois casos foram utilizados para ilustrar o sucesso da combinação antibiótico e corticoide, ambos sobre meninos de 13 anos de idade que haviam aspirado objetos metálicos e pontiagudos.…”

“…A primeira tentativa de retirada por broncoscopia falhou e os pacientes foram submetidos ao tratamento farmacológico, sendo posteriormente reencaminhados ao setor de endoscopia onde os CE foram facilmente localizados e removidos (15) .…”

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

“…A history of foreign body inhalation is the key to diagnosing bronchial foreign bodies. 18 Most patients have a definite history of foreign body inhalation, while a small number have an unclear history with complaints of a repeated irritating cough, wheezing, fever, and so on. At this point, a chest CT or X-ray examination is needed.…”