Foreign Body Inhalation: A Review of Patients at the Korle Bu Teaching Hospital, Accra, Ghana

Abstract

BACKGROUND: Foreign body inhalation, a surgical emergency requiring prompt management to avoid morbidity and mortality , poses a diagnostic and management challenge to otolaryngologists. OBJECTIVE: To assess the pattern of foreign body inhalation at the ENT Unit Korle Bu Teaching Hospital Accra, Ghana. METHODS: The theatre records of patients managed for foreign body inhalation from Ist January 2003-31st December 2006 at the ENT Unit of the Korle Bu Teaching Hospital Accra, Ghana were studied with respect to age, sex, clinical presentation, types of foreign bodies removed, location of foreign bodies, and outcomes of the laryngoscopy or bronchoscopy procedures. RESULTS: There were forty patients with an age range of seven months to 15 years with a mean age of 4.78 years and a peak age incidence at zero-four year age group. The commonest inhaled foreign bodies included groundnuts in five (12.5%) patients, fish bones in six (15%) patients, plastic materials in five (12.5%) patients, metal material in five (12.5%) patients and seeds in five (12.5%) patients. The common clinical presentations included respiratory difficulty, irritating cough, choking, painful swallowing and whistling sound during breathing. Foreign bodies were localized in the right main bronchus in 27 (67.5 %) patients, and in the left main bronchus in ten (25%) patients and in the larynx in three (7.5%) patients. One patient died during bronchoscopy and another patient had bronchotomy for failed bronchoscopy.

Inhaled foreign bodies in a paediatric population at AKTH Kano-Nigeria

“…The commonest organic FB inhaled in children is the groundnut and this concurs with our finding (25.7%) and is corroborated by other studies as well 1011162122. In contrast, a recent study in Kenya revealed that the commonest organic FB in their series was beans while the second were peanuts/groundnuts 6…”

Foreign Body Aspiration: Imaging Aspects

“…The incidence of right and left bronchial foreign bodies is almost equal in infants and young children (Mu et al 1990;Black et al 1994;Burton et al 1996;Cataneo et al 1997; Senkaya et al 1997;Metrangelo et al 1999;Oguz et al 2000;Van Looij et al 2003;Ayed et al 2003;Pinto et al 2006;Zhijun et al 2008;Cohen et al 2009;Rodriguez et al 2013), as opposed to predominance of the right bronchial tree in older children, adolescents, and adults (Baharloo et al 1999;Fraga Ade et al 2008;Roda et al 2008;Kitcher 2009;de Sousa et al 2009;Saki et al 2009;Falase et al 2013;Sidell et al 2013). These differences can partly be explained by the almost symmetrical tracheobronchial angle in younger children (Cleveland 1979) and by the position of the carina that is more commonly seen left to the midline (Tahir et al 2009).…”

“…Most cases of foreign body aspiration occur between the age of 6 months and 3 years, with the highest incidence during the second year of life (Mantel and Butenandt 1986;Piepsz 1988;Fitzpatrick and Guarisco 1998;Lima and Fischer 2002;Witt 1985;Roda et al 2008;Kitcher 2009;de Sousa et al 2009;Orji and Akpeh 2010;Pan et al 2012;Paksu et al 2012;Boufersaoui et al 2013;Sidell et al 2013;Tenjovic et al 2013). Infants and toddlers in this age group are already ambulatory and can therefore ''disappear'' from parent or guardian supervision for varying periods of time.…”

“…Foreign body aspiration is the most frequent pediatric domestic accident, and has serious and sometimes fatal sequelae (Black et al 1984;Fitzpatrick and Guarisco 1998;Bhana et al 2000;Ciftci et al 2003;Qureshi and Mink 2003;Li et al 2009;Gang et al 2012;Pan et al 2012;Foltran et al 2013;Bamber et al 2013). Most cases occur under the age of 4 years (Mantel and Butenandt 1986;Esclamado and Richardson 1987;Piepsz 1988;Schmidt and Manegold 2000;Oguz et al 2000;Lima and Fischer 2002;Roda et al 2008;Kitcher 2009;de Sousa et al 2009;Goktas et al 2010;Orji and Akpeh 2010;Paksu et al 2012;Pan et al 2012;Boufersaoui et al 2013). When the history of a foreign body aspiration is definite, bronchoscopy is the modality of choice for both diagnosis and management (Cohen et al 2009;Ezer et al 2011;Mortellaro et al 2013;Samkani et al 2013).…”

“…About three quarters of airway foreign bodies are found in the main bronchi (Blazer et al 1980;Mantel and Butenandt 1986;Zhijun et al 2008;Kitcher 2009;Saki et al 2009), where they cause partial or complete obstruction. Plain films and fluoroscopy seldom demonstrate a nonopaque foreign body.…”