Rigid Bronchoscopy in Pediatric Patients

Abstract

Aspiration of foreign-bodies remains a major life-threatening situation in children and have always been a source of interest and confusion to otolaryngologists due to their varied presentations. These conditions if not promptly diagnosed and managed can prove to be fatal, but the current mortality is only one percent compared to pre bronchoscopy era (Rothman and Boeckman in Ann Otol Rhinol Laryngol 89:434-436, 1980). Peak incidence of this condition is in early childhood due to child's habit of putting small objects in mouth to determine their taste and texture and chew while teething. This is a study conducted retrospectively from 2012 to 2017 in a teritiary care center. It includes a total of 70 cases of foreign body in airway who underwent rigid bronchoscopy under general anaesthesia. The patients were all in paediatric age group but mostly between 6 months to 3 years. The youngest patient was 3 months old and the oldest 12 years old. Male children (70%, n = 49) were more common than female children (30%, n = 21) with a male to female ratio of 2.33:1. A definite history of foreign body aspiration was given in only 70% cases, but the most common symptom were cough (100%) and breathlessness (80%). Organic foreign bodies (76.36%, n = 42) were more common when compared to inorganic foreign bodies. Foreign body most commonly impacted in Right main bronchus (49.09%, n = 27) followed by Left main bronchus (31.42%) and lastly the trachea (19.49%). Even though the mortality in patients of foreign body aspiration is low, it is essential to have proper cooperation between the otolaryngologists, paediatrician and the radiologist for rapid diagnosis and prompt management. It is advised to have a second look to check all the bronchopulmonary segments. Life saving steps are Prompt referral, early diagnosis and vigilant management.

Foreign Body Aspiration in Left Bronchus in a Pediatric Patient - A Case Report

“…The chance of positive foreign body based onhistory varies from 70% to 94% in various studies. 4,5 In the present case parents never observed any paroxysmal event suchas cough, choking or sudden onset breathing difficulty which lead to foreign body aspiration the last differential diagnosis. In addition, symptoms were mild in our patient and presence of mild fever pointed more towards an infective etiology, hence child was diagnosed to have pneumonia and started on intravenous antibiotics.…”

“…This may be due to absent denture, still adjusting to descent of larynx, habit of crying, speaking while eating and uncoordinated swallowing reflexes. 4 The…”

“…In a studyby Vikas et al foreign body most commonly gets impacted in right main bronchus (49.09%) followed by left main bronchus (31.42%) and lastly the trachea (19.49%). 4 This prompted the need for diagnostic cum therapeutic Flexible bronchoscopy. Flexible bronchoscopy is a safe procedure in experienced hands compared to ancient times due to better illumination, Hopkins rod lens systemand usage of ventilating bronchoscope.…”

“…3 Foreign body aspiration is more common inright bronchus than left bronchus due to its anatomy. 4 Sudden onsets of coughing and choking are the most common presenting symptoms. The appearance depends on the degree of airway blockage and the site of the objects as well as the age, type of object.…”

Pill in the left bronchus-pediatric foreign body aspiration: a case report

“…3 Foreign body aspiration is more common in right bronchus than left bronchus due to its anatomy. 4 Sudden onset of coughing and choking are the most common presenting symptoms. 5 The presentation depends on the degree of airway blockage and the location of the objects as well as the age of the child, the type of object.…”