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Bronchoscopy for foreign body removal in children. A review and analysis of 210 cases
C E Skoulakis1, P G Doxas, C E Papadakis
1Department of Otolaryngology, University of Crete School of Medicine, Heraklion, Greece.
Insights
Pediatric foreign body aspiration requires prompt diagnosis, even without clear symptoms. Bronchoscopy identified foreign bodies in 130 children, often in the main bronchi, highlighting the need for vigilance.
Area of Science:
- Pediatric Pulmonology
- Pediatric Emergency Medicine
- Otolaryngology
Background:
- Foreign body aspiration in the tracheobronchial tree is a critical pediatric emergency with potentially fatal outcomes.
- Diagnosis can be challenging due to non-specific clinical and radiographic findings.
Purpose of the Study:
- To review pediatric cases of suspected foreign body aspiration treated with bronchoscopy.
- To analyze the incidence, location, and outcomes of foreign body aspiration in children.
Main Methods:
- Retrospective review of 210 pediatric cases with a history suggestive of foreign body aspiration.
- Bronchoscopy performed under general anesthesia using a Storz ventilation bronchoscope.
Main Results:
- A foreign body was identified in 130 patients (62% of cases).
- The majority of foreign bodies were located in the right (60%) and left (33.1%) main bronchi.
- The incidence of bronchoscopy for foreign body aspiration was 28 procedures per 100,000 children annually in Crete.
Conclusions:
- A high index of suspicion based on patient history is crucial for diagnosing foreign body aspiration.
- Radiographs should be used as supplemental information to guide the decision for bronchoscopy.
- Parental education on preventing aspiration of small objects and appropriate eating habits in children is essential.
Objective:
A foreign body aspiration in the tracheobronchial tree is a dangerous and common medical emergency in childhood, with serious and potentially lethal consequences. It must be suspected in children with a suggestive history, even though the clinical symptoms or radiographic findings are not pathognomonic for foreign body aspiration.
Methods:
In this study 210 pediatric cases, with a suggestive history of foreign body aspiration undergoing bronchoscopy in the last 8 years in the department, were reviewed. In all cases bronchoscopy was performed under general anesthesia using a Storz ventilation bronchoscope with distal cold light illumination.
Results:
In 130 patients a foreign body was discovered, in 17 cases pus was aspirated and in 63 cases there were no findings. Seventy-eight (60%) foreign bodies were found in the right main bronchus, 43 (33.1%) in left main bronchus, seven (5.4%) in both bronchi and two (1.5%) were found in the subglottic area. The incidence of bronchoscopy during the last 8 years was 28 procedures per 100000 children population per year in the island of Crete.
Conclusion:
More attention should be given to the need for a careful history and the use of radiographs as supplemental information to make the decision to perform a bronchoscopy. The parents, also, should pay attention not to allow children dry fruits and small toys, as well as, teaching their children to avoid any physical or emotional activity while having a full mouth.