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

Abstract

Aspiration of tracheobronchial foreign bodies commonly affects young children, is potentially life threatening and requires early intervention for extraction. Access to facilities and skill manpower for bronchoscopic extraction is however limited in Nigeria. The aim of this study is to describe the experience in our institution with bronchoscopic removal of tracheobronchial foreign bodies and highlight the challenges encountered. This is a retrospective study of all patients referred to the Lagos State University Teaching Hospital with a diagnosis of tracheobronchial foreign body within the period of February 2008 and February 2013. Data extracted from the medical records were age, sex, time interval between aspiration and presentation, location of tracheobronchial foreign body, bronchoscopic technique, complications and outcome. A total of 24 patients were referred and confirmed at bronchoscopy to have tracheobronchial foreign bodies. Mean age was 6.6 + 5 years. Male to female ratio was 1:1. Delayed presentation was common with 22 patients (91.7%) presenting more than 24 hours after aspiration. Aspirated material was inorganic in 17 patients (70.8%) and organic in 7 patients (29.2%). Location of tracheobronchial foreign bodies was right main bronchus in 16 patients (66.7%), left main bronchus in 6 patients (25%) and the trachea in 2 patients (8.3%). Challenges to speedy and safe removal of the foreign bodies were delayed presentation and a limited range of bronchoscopic equipment early in the series which caused prolonged procedures and increased complications. Two mortalities occurred early in the series; one from airway obstruction and the other from respiratory failure caused by tracheobronchial oedema. Extraction of tracheobronchial foreign bodies was faster, more complete and safer later in the series due to a wider range of bronchoscopy equipment which included both flexible and rigid videobronchoscopy with the use of optical forceps. This preliminary experience suggests that an adequate armamentarium of bronchoscopy equipment is required to increase the chances of complete extraction, speed up the procedure and reduce the risk of complications of Tracheobronchial Foreign Bodies in our environment. Delayed presentation increases the difficulty of the procedure so earlier referral of these patients would help reduce the risk involved in their management.

The challenges of cardiothoracic surgery practice in Nigeria: a 12 years institutional experience

“…Various reports from Nigeria have shown that there is a large burden of upper aerodigestive tract foreign bodies that presents as emergencies (16,17) and the necessary equipment is not always available, necessitating invasive procedures like tracheostomy to establish an airway (16) and bronchotomy or esophagotomy to remove the foreign body (8,9). Fortunately, as our center has been able to invest in a full range of flexible and rigid scopes we apply endoscopy for the successful removal of most foreign bodies (17). Adeoye et al reported on peripheral vascular procedures in Ilorin over a 2-year period (18).…”

Foreign Body Bottom of Pen in Bronchus with and without Atelectasis

“…The advances in anaesthesia have reduced the mortality and greatly facilitated the task of the endoscopist by allowing simultaneous visualization and manipulation of the foreign bodies. 11,12 with a magnifyinglens system at the distal end. The tip of the bronchoscope can beangulated using a steering wheel at its distal end and on most thereare suction and injection ports.…”

“…With modern bronchoscopy equipment, thoracotomy with bronchotomy and segmental resection of the lung as part of the management of bronchial foreign bodies has been largely relegated to the past. 11,12 It is important to select an instrument of suitable size for the patient's airway; a guide to selecting bronchoscope size can be found in Table 3. The size refers to the nominal internal diameter (ID); this dictates ease of ventilation (spontaneous and manual) and suctioning.…”

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).…”

“…Until recently, rigid or flexible bronchoscopy was used for diagnosis, while removal of foreign bodies was carried out by rigid bronchoscopy only (Friedman 2000;Lima and Fischer 2002;Ayed et al 2003;Ciftci et al 2003;Lima et al 2008;Cohen et al 2009;Albirmawy and Elsheikh 2011). With the advance of technology, removal of foreign bodies can now be done by flexible bronchoscopy, which is a shorter and safer procedure (Swanson and Edell 2001;Tang et al 2006;Zhijun et al 2008;Rodrigues et al 2012a;Falase et al 2013). The complication rate of bronchoscopy varies between 1 and 8 % (Black et al 1984;Steen and Zimmermann 1990;Zerella et al 1998;Zaytoun et al 2000;Ayed et al 2003;Ciftci et al 2003;Cohen et al 2009;Kiyan et al 2009), and the mortality rate is as low as 0.25-1 % (Mu et al 1990(Mu et al , 1991Steen and Zimmermann 1990;Hoeve and Rombout 1992;Ciftci et al 2003;Zhijun et al 2008;Rodrigues et al 2012b).…”