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Management of Tracheo-Bronchial Foreign Bodies in Children: Our Experience
Ganesh Chandra Gayen1, Debabrata Das2, Ritam Ray3
1Department of ENT and Head Neck Surgery, Malda Medical College and Hospital, Singatala, Uma Roy Sarani, Malda Town, West Bengal 732101 India.
Insights
Pediatric foreign body aspiration requires prompt bronchoscopic removal, especially in airway emergencies. Unresolved lower respiratory tract infections (LRTIs) may indicate missed foreign bodies, necessitating careful investigation.
Area of Science:
- Pediatric Pulmonology
- Pediatric Surgery
- Medical Imaging
Background:
- Foreign body aspiration is a significant cause of pediatric respiratory distress.
- Delayed diagnosis and management can lead to severe complications, including airway obstruction and persistent lower respiratory tract infections (LRTIs).
- Bronchoscopy is a crucial diagnostic and therapeutic tool in managing pediatric airway foreign bodies.
Purpose of the Study:
- To investigate the epidemiological characteristics of pediatric patients undergoing foreign body removal.
- To evaluate the diagnostic modalities used for foreign body confirmation.
- To assess the incidence and nature of post-operative complications.
Main Methods:
- A prospective hospital-based study included 36 pediatric patients over two years (August 2017-July 2019).
- Informed consent was obtained prior to bronchoscopy.
- Patients underwent clinical examination, investigations, bronchoscopic foreign body removal, and follow-up at 1 and 3 months.
Main Results:
- 12 patients presented with airway emergencies requiring immediate bronchoscopic intervention.
- 10 patients with suspected aspiration underwent clinical and radiological evaluation before bronchoscopy.
- 14 patients were referred for unresolved LRTIs, highlighting the importance of considering missed foreign bodies.
Conclusions:
- Early bronchoscopic intervention is life-saving in pediatric foreign body aspiration.
- Unresolved LRTIs in children warrant thorough investigation for potential missed foreign bodies.
- High-resolution computed tomography (HRCT) Thorax with 3-D reconstruction aids in precise foreign body localization.
Abstract:
(1) To study the epidemiological profile of the patients. (2) To study the various modalities of investigations to arrive at confirmatory diagnosis. (3) To study the post-operative complications. It was a hospital based prospective study. A total of 36 paediatric patients were included in the study over a duration of 2 years (August 2017 to July 2019). Written informed consent was taken from the parent of each patient before performing bronchoscopy. All the patients were subjected to careful clinical examination and investigations required followed by emergency bronchoscopic removal of foreign body. The patients were followed up at 1 and 3 months after bronchoscopic removal. Amongst the 36 cases, 12 cases presented with airway emergency which addressed by bronchoscopic removal immediately. 10 cases presented with suggestive history of foreign body aspiration were subjected to clinical and radiological studies followed by bronchoscopic removal. 14 cases were referred from paediatric in-patient department who were being treated for unresolved LRTI. Early intervention is life saving if timely done. Unresolved LRTIs should be looked carefully to address missed foreign bodies. HRCT Thorax with 3-D reconstruction (Virtual Bronchoscopy) helps in exact localization of the foreign body. Experienced team of surgeons and anesthetist along with a ICU support is needed for efficient management.
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