Foreign Bodies Aspirated in Children: Role of Bronchoscopy

Abstract

Objective: To examine the diagnostic and therapeutic role of fiber-optic and rigid bronchoscopy in pediatric patients with foreign body inhalations. Methods: From January 1986 to December 2004, we observed 128 young patients with suspicion of foreign body aspiration. Patients were divided into 3 groups: group I, patients with negative chest X‐ray; group II, patients with radiological direct signs; group III, patients with radiological indirect signs. Results: Removal of the foreign body was effected in 105 patients by rigid bronchoscopy and in 13 patients by fiber-optic bronchoscopy. In 3 group II patients a thoracotomy with a bronchotomy was necessary. Conclusions: Fiber-optic bronchoscopy showed a diagnostic accuracy rate of 100 % but played a poor therapeutic role with a case resolution of 10.7 %. Rigid bronchoscopy was the main technique, permitting the removal of the tracheobronchial foreign body in 97.2 % of patients.

Key words

thoracic surgery - rigid bronchoscopy - fiber‐optic bronchoscopy - diagnosis - surgical treatment

References

• 1 Sadan N, Raz A, Wolach B. Impact of community educational programmes on foreign body aspiration in Israel.  Eur J Pediatr. 1995;  154 859-862
• 2 Baharloo F, Veyckemans F, Francis C, Biettlot M P, Rodenstein D O. Tracheobronchial foreign bodies; presentation and management in children and adults.  Chest. 1999;  115 1357-1362
• 3 de Oliveira C F, de Almeida J FL, Troster E J, Costa Vaz F A. Complications of tracheobronchial foreign body aspiration in children: report of 5 cases and review of the literature.  Rev Hosp Clin. 2002;  57 108-111
• 4 Sersar S I, Hamza U A, Abdelhameed W A, Abulmaaty R A, Gowaeli N N, Moussa S A, Almorsi S M, Hafez M M. Inhaled foreign bodies: management according to early or late presentation.  Eur J Cardiothorac Surg. 2005;  28 369-374
• 5 Girardi G, Contador A M, Castro-Rodriguez J A. Two new radiological findings to improve the diagnosis of bronchial foreign-body aspiration in children.  Pediatr Pulmonol. 2004;  38 261-264
• 6 Pogorzelski A, Zebrak J. Bronchofibroscopy in removal of foreign bodies from the bronchi in children.  Pneumonol Alergol Pol. 1995;  63 652-656
• 7 Swanson K L, Prakash U BS, Midthun D E, Edell E S, Utz J P, McDougall J C, Brutinel W M. Flexible bronchoscopic management of airway foreign bodies in children.  Chest. 2002;  121 1695-1700
• 8 Downey R J, Libutti S K, Gorenstein L, Mercer S. Airway management during retrieval of the very large aspirated foreign body: a method for the flexible bronchoscope.  Anesth Analg. 1995;  81 186-187
• 9 Marzo S J, Hotaling A J. Trade-off between airway resistance and optical resolution in pediatric rigid bronchoscopy.  Ann Otol Rhinol Laryngol. 1995;  104 282-287
• 10 Ahmed A A. Bronchoscopic extraction of aspirated foreign bodies in children in Harare.  East Afr Med J. 1996;  73 242-244
• 11 Boelcskei P L, Wagner M, Lessnau K K. Laser-assisted removal of a foreign body in the bronchial system of an infant.  Lasers Surg Med. 1995;  17 375-377
• 12 Farrel P T. Rigid bronchoscopy for foreign body removal: anaesthesia and ventilation.  Pediatr Anaesth. 2004;  4 84-89
• 13 Causey A L, Talton D S, Miller R C, Warren E T. Aspirated safety pin requiring thoracotomy: report of a case and review.  Pediatr Emerg Care. 1997;  13 397-400
• 14 Ulku R, Baskan Z, Yavuz I. Open surgical approach for a tooth aspirated during dental extraction: a case report.  Aust Dent J. 2005;  50 49-50