A simple management option for chronically impacted sharp tracheobronchial foreign bodies in children

Area of Science:

• Pediatric Pulmonology
• Interventional Pulmonology
• Pediatric Surgery

Background:

• Distally impacted chronic tracheobronchial sharp foreign bodies in children pose significant management challenges due to subtle presentation and variability.
• Previous management strategies include advanced techniques like image guidance, specialized instrumentation, tracheotomy, thoracotomy, and extracorporeal membrane oxygenation.
• Endoscopic removal is often complicated by the foreign body's distal location, inflammatory reactions, granulation tissue, and bleeding.

Observation:

• Two pediatric cases of aspirated impacted sharp metallic foreign bodies in the distal airway were managed.
• The foreign bodies were lodged in challenging distal locations within the tracheobronchial tree.
• Clinical presentation was subtle, characteristic of chronic impaction.

Findings:

• Successful removal of impacted sharp metallic foreign bodies from the distal airway was achieved using rigid bronchoscopy.
• Maximal medical therapy was administered prior to the endoscopic intervention.
• Rigid bronchoscopy proved effective despite the challenges of distal location and inflammatory changes.

Implications:

• Rigid bronchoscopy, following maximal medical therapy, is a viable and effective approach for managing distally impacted sharp metallic foreign bodies in children.
• This approach offers a less invasive alternative to surgical procedures in select cases.
• Further investigation into optimizing pre-procedural medical management may enhance outcomes for pediatric airway foreign bodies.