The Challenges in Removal of Aspirated Tracheobronchial Foreign Bodies
Background: Foreign body aspiration has remained a consistent problem since decades
with 80% of all aspirations occurring in children with a significant morbidity and mortality
especially in young children.
Objective: To overview the technical difficulties and challenges of removal of different
types of inhalational foreign bodies.
Methods: Forty patients out of 281 patients presented with suspicious cases of foreign
body inhalation considered as challenging and difficult cases in removal of the foreign
bodies from January 2009 to December 2014 in the thoracic department of Baghdad
Medical City Teaching Complex according to certain criteria. Rapid and thorough history
was taken with quick clinical examination for stridor, severe shortness of breath, or stupor
with radiological examination of neck and chest. Urgent bronchoscopes under general
anesthesia were done to all patients. Different equipment was used to aid removal of
these foreign bodies such as: flexible bronchoscope through the rigid, flexible grasping
biopsy forceps with the telescope, optical forceps, Fogarty balloon catheters as well as
fluoroscopic screen. Thoracotomy and surgical intervention would be considered.
Results: There were 40 patients (14.2%) among 281 patients with foreign body
inhalations in whom difficulties in removal of the foreign bodies were encountered. There
were (21) males and (19) females with mean age of 4.67 years and the most affected
group was below 3 years of age (67.5%). Definitive history of foreign body inhalation was
60%. The most presenting symptoms were cough 90%, shortness of breath and dyspnea
47.75%, and stridor 27.5%. Chest X ray was positive for the metallic objects in 32.5% and
10% with indirect signs and only one patient had CT scan of chest. Several attempts on
same session of bronchoscope were done in 57.5% of patients in order to remove the
difficult types of foreign bodies, while in 35% of the patients the foreign bodies were
removed from the first attempt. Repeated bronchoscopes within next 48-72 hours needed
in 7.5% due to either impaction to the bronchial wall or granulation tissue formation. Only
one patient (2.5%) underwent surgery after failed removal by bronchoscope. There was
Conclusion: Every bronchoscope unit should be well-equipped with different and suitable
equipment and bronchoscopy should be done by a well-trained bronchoscopist. There
should be no hesitation in postponing the bronchoscope to other trials to avoid surgery.
Keywords: Aspiration, Inhalational foreign body, Tracheobronchial tree, Foreign
body, Challenges in inhalational foreign body.
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