Spontaneous expulsion and migration of a bronchial foreign body: A flustering rare dental accident

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comSpontaneous expulsion and migration of a bronchial foreign body: A flustering rare dental accident Koken Ameku, Mariko Higa ABSTRACT Introduction: A bronchial foreign body is a dangerous medical emergency that is potentially life threatening. Spontaneous expulsion should neither be expected nor experienced; thus, early removal with a bronchoscope should be performed to prevent complications. Spontaneous expulsion of a bronchial foreign body is rare, with few cases reported. Additionally, its occurrence and associated clinical complications are not studied and unclear. We describe a patient in whom a bronchial foreign body was expectorated spontaneously and swallowed into the digestive tract. Case Report: An 80-year-old male aspirated a tooth in the left lower airway during a dental procedure. Flexible bronchoscopy performed on the next day found no foreign body in either bronchial tree. However, it was found on the abdominal radiograph. It was considered to have been expectorated and then swallowed before bronchoscopy. One week later, the patient had passed it.Conclusion: This case demonstrated that a bronchial foreign body can rarely be expelled spontaneously. Besides, an expelled foreign body can be swallowed, or it can migrate to another location. Regarding spontaneous expectoration and migration, injury to the airway and digestive tract can occur depending on its shape. However, such dangers have not been addressed, because spontaneous expectoration is rare and unrecognized. Recognizing these dangers and warning patients of them could avoid additional complications.

Eliminação espontânea de corpo estranho em via aérea inferior: um relato de caso

“…Outros são determinados pelo tamanho e localização do CE [12] e podem incluir sibilos, dor torácica, hemoptise, febre, falta de ar, asfixia e pneumonia pós-obstrutiva recorrente [1,3,10]. As complicações respiratórias dessa retenção incluem edema laríngeo, laceração traqueal, enfisema pulmonar, presença de enfisema subcutâneo, empiema, pneumomediastino ou pneumotórax, pneumonia necrosante, broncoestenose, bronquiectasia pós-obstrutiva, bronquiolite, fístulas broncopleural e broncocutânea, atelectasia e osteomielite das costelas [1,2,6].…”

“…A aspiração geralmente é acidental, mas pode ocorrer por causas iatrogênicas. Durante procedimentos odontológicos e outros invasivos em posição supina [12], como intubação endotraqueal, laringoscopia ou broncoscopia rígida [1], é possível que dentes, dentaduras, cápsulas endoscópicas e peças quebradas de instrumentos se alojem inadvertidamente nas vias aéreas [2].…”

“…Dentre as técnicas, uma taxa global de sucesso de 92% é reservada para a broncoscopia flexível [2,15]. A broncoscopia rígida é preferida em crianças e adolescentes sem comorbidades, maior tempo de aspiração, materiais de consistência rígida e tentativas prévias de remoção fracassadas [16].…”

“…A aspiração de corpo estranho (CE) é uma emergência médica potencialmente fatal, apesar de incomum [1,2]. Esta patologia é enigmática por uma ampla variedade de apresentações clínicas dos pacientes que variam de assintomáticos a sintomas graves como a asfixia [3,4].…”

“…A eliminação espontânea do CE é rara [5] e não deve ser considerada como conduta. A remoção broncoscópica precoce é absolutamente necessária [2,3,6]. Caso contrário, há risco de migração subglótica do material e apneia súbita [7].…”