Tracheobronchial Foreign Bodies : A Challenge in the Rural Setup

Abstract

Accidental foreign body aspiration represents a common problem in India, especially in the pediatric population. The main challenges facing an otolaryngologist in rural tertiary care Centre's of developing countries include the significant delays in referral, the relative lack of sophisticated equipment at the surgeons' disposal and the mortality associated with loss of airway. MATERIALS AND METHODS: All patients who underwent bronchoscopy for suspected aspiration of foreign bodies in North Bengal Medical College, Darjeeling, between June, 2012 and May, 2014 were included in the study. All patients underwent rigid bronchoscopy under general anesthesia. Foreign bodies, when found, were removed using conventional grasping forceps. RESULTS: Thirty-six patients were admitted for suspected tracheobronchial foreign body (TFB) during the study period. The presentation pattern was highly variable between the patients although the predominant presenting complaint was that of respiratory distress (63.9%). The interval between suspected accidental inhalation and presentation ranged from 1 to 31 days. The foreign bodies retrieved were classified into four broad groups. Seeds and nuts were the most common foreign body. The site of lodgment of the foreign body in the tracheobronchial tree was also variable. CONCLUSION: Our experience in a rural tertiary care centre in West Bengal has shown that a high index of suspicion must be present to diagnose such cases as early as possible. Digital radiographs might be normal in a considerable number of cases and any suspicion of a TFB should warrant a bronchoscopic examination. Symptoms like choking and cough may not be always present and even a definite history of accidental foreign body aspiration may be absent.