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Foreign body aspiration with iatrogenic right bronchus perforation - A case report and literature review
Bijay Sah1, Lokesh Shekher Jaiswal1
1Department of Cardiothoracic and Vascular Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Insights
Foreign body removal from the trachea can lead to tracheobronchial injury (TBI). Prompt diagnosis and surgical repair of TBI are crucial for patient survival and recovery.
Area of Science:
- Medical Case Reports
- Surgical Complications
- Pediatric Emergency Medicine
Background:
- Foreign body (FB) in the trachea presents significant removal challenges and risks of life-threatening complications.
- Iatrogenic tracheobronchial injury (TBI) is a rare but severe complication requiring immediate diagnosis and intervention.
Observation:
- An 11-year-old child presented with cough and chest discomfort due to a right main bronchus foreign body.
- Initial rigid bronchoscopy failed, leading to surgical emphysema and a ruptured right main bronchus with FB migration.
- A repeat CT scan confirmed the tracheobronchial injury and FB location in the pleural cavity.
Findings:
- Successful removal of the foreign body and repair of the ruptured right main bronchus were achieved via thoracotomy.
- The child's vital signs remained stable throughout the procedure.
- The patient was discharged on the seventh post-operative day with normal vital signs.
Implications:
- Timely diagnosis and management of tracheobronchial injury are critical for preventing fatal outcomes.
- Definitive surgical repair of TBI significantly improves patient prognosis.
- This case highlights the importance of prompt intervention in managing complex airway foreign body complications.
Introduction And Importance:
Evacuation of obstructed trachea foreign body (FB) can be challenging and may have several life-threatening complications. Iatrogenic tracheobronchial injury (TBI) is a rare and devastating complication which need prompt diagnosis and management.
Case Presentation:
An 11-year-old child was brought to the emergency with a history of cough and chest discomfort for the last 15 days. Chest x-ray and computed tomography (CT) chest were done which showed the presence of a FB in the right main bronchus. After all pre-operative investigations, rigid bronchoscopy and removal of the foreign body under general anesthesia was performed. After several attempts, the foreign body couldn't be removed and there was massive surgical emphysema of the chest. Immediately bilateral chest tube was inserted. A repeat CT chest was done which revealed a ruptured of the right main bronchus with migration of the foreign body to the right pleural cavity. Right thoracotomy was performed under general anesthesia. The foreign body was removed and the bronchus ruptured was repaired. The child's vital signs were normal throughout the procedure and she was discharged on the seventh post-operative day.
Clinical Discussion:
TBI can have devastating scenarios in the absence of quick diagnosis and treatment. Around 80 % of patients with TBI due to accidents have been found to have fatal outcomes before reaching the hospital, probably due to tension pneumothorax, hypoxia, or respiratory failure.
Conclusion:
Prompt diagnosis and management of complications with definitive repair of the injury were key elements in saving lives after TBI.
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