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Tracheobronchial foreign body aspiration in childhood. A report on 224 cases
Insights
Pediatric foreign body aspiration is common in children under three, with nuts being the most frequent culprit. Early diagnosis and endoscopic removal are crucial to prevent chronic respiratory damage.
Area of Science:
- Pediatric Pulmonology
- Otolaryngology
- Emergency Medicine
Background:
- Foreign body aspiration is a significant cause of respiratory distress in young children.
- Nuts, particularly peanuts, are the most common aspirated foreign bodies.
- Delayed diagnosis can lead to severe, chronic lung damage.
Purpose of the Study:
- To analyze the characteristics of foreign body aspiration in children.
- To evaluate the efficacy and safety of endoscopic foreign body removal.
- To highlight the importance of early diagnosis and intervention.
Main Methods:
- Retrospective analysis of 224 pediatric patients undergoing foreign body extraction.
- Endoscopic removal under general anesthesia with muscle relaxation.
- Development and application of an "encasing" technique for crumbling foreign bodies.
Main Results:
- Most patients (81%) were under 3 years old, with a 2:1 male-to-female ratio.
- Nuts accounted for 67% of foreign bodies, predominantly peanuts.
- Endoscopic removal was successful in all cases with rare complications; an "encasing" technique facilitated crumbling foreign body removal.
- One-third of cases had delayed intervention (>3 weeks), leading to chronic damage.
Conclusions:
- Foreign body aspiration in children is a frequent occurrence, primarily involving nuts in toddlers.
- Endoscopic extraction is a safe and effective treatment, with novel techniques improving outcomes for challenging foreign bodies.
- Prompt diagnosis and intervention are critical to prevent long-term respiratory sequelae; prevention strategies remain limited.
Abstract:
In 224 patients aged 7 months to 14 years aspirated foreign bodies (FB) were extracted from the tracheobronchial system. Eighty-one percent of the children were younger than 3 years, 50% were in the second year of life. There were twice as many boys as girls. Sixty-seven percent of the FB were nuts, of these more than half were peanuts. Fifty-six percent of aspirated FB were localized in the right bronchial system, 39% in the left and 5% subglottic or tracheal. All FB could be removed by endoscopy under general anaesthesia with muscle relaxation. The development of an extraction technique without forceps ("encasing") led to an easier way of removing crumbling FB, like nuts. Complications were rare, no postoperative tracheotomy was necessary, no cardiac arrest and no death occurred. The interval between aspiration and intervention was longer than 3 weeks in one-third of the cases; in some cases it was months or years with the consequence of chronic damage of the bronchial system or the lung. The possibilities of prevention appear to be limited; thus it is necessary to diminish the frequency of prolonged lodging of FB in the respiratory tract by considering aspiration early in the differential diagnosis of airway symptoms.