The management of complicated airway foreign bodies in children: our institutional experience

Abstract

INTRODUCTIONForeign body (FB) aspiration is typically seen in preschool children. 1,2,4Exploring nature and inquisitiveness of these babies is commonly attributed for FB aspiration. 2,4,5 The majority of acute foreign body aspirations presents dramatically and can be safely extracted with rigid or flexible bronchoscopy with optical forceps.5 However, on rare occasions these patients may present with complications related to FB impaction and its effects distal to it. We present our study on complicated airway FBs and their surgical management in children. ABSTRACTBackground: Foreign body (FB) aspiration is typically seen in preschool children. The main objective was to study the utility of open surgical treatment for complicated airway foreign bodies in children. Methods:This was a retrospective analysis of data pertaining to complicated airway foreign bodies managed at our institution between 1997 January to December 2015. The demographic data, clinical presentation, radiological studies, surgical management, complications, duration of hospital stay and follow up were recorded and analysed. The diagnosis of FB aspiration was made from documented clinical features and radiological investigations. The treatment included rigid bronchoscopy and surgical interventions as and when required. Results: During the study period of 120 months, a total of 635 children with FB aspiration were treated at our institution. All of them underwent initially, rigid bronchoscopy and attempted FB retrieval. It was successful in 624 patients and 11 patients had complicated airway FB which could not be retrieved endoscopically. Among eleven patients analysed in the present study, 7 were males and 4 were females. The age of the patients ranged from 6 months to 16 years, the average age being 5.7 years. All of them did well postoperatively except one mortality. Conclusions: Timely intervention with the experienced surgical team would minimize the complication rate and mortality rate. The concomitant performance of a tracheotomy is indicated for patients who have aspirated particularly wide FBs, which do not pass the subglottic region and in sharply pointed FBs whose points lodge in the subglottic region presenting with respiratory distress. Open surgical procedures including thoracotomy and bronchotomy for retrieval of impacted bronchial FB are invaluable adjunctive procedures for management of complicated FB aspirations.

Surgical retrieval and successful bronchial repair for impacted foreign body: a case report

“…Elaziz, M.A., et al [2] have also performed bronchotomy, but their experience was limited to pediatric cases only. Aihole JS et al [3] reported their experience, but it was also limited to pediatric cases only. So far, the experience of surgical retrieval of impacted foreign bodies in adults is limited.…”

Needle in the Lung: A Difficult Case of Pulmonary Foreign Body

“…plicated FBA and are strategic (15)(16)(17)(18). In a study by Fraga et al (19), the authors report a case of an 8-year-old boy presenting with an airway foreign body that was too large to be extracted through the subglottic region.…”