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Published on: September 11, 2018
Unusual Airway Foreign Bodies in Children: Demographics and Management
Sumona Bose1, Attibele Mahadevaiah Shubha2
1Department of Paediatric Surgery, All India Institute of Medical Sciences, Kalyani, West Bengal, India.
Insights
Unusual airway foreign bodies (UAFBs) in children are not uncommon, with boys predominantly affected. Bronchoscopic removal is challenging but offers favorable outcomes for these UAFBs.
Area of Science:
- Pediatric Pulmonology
- Pediatric Otolaryngology
- Medical Device Technology
Background:
- Unusual airway foreign bodies (UAFBs) represent a distinct challenge in pediatric respiratory emergencies.
- Exclusion of common aspirated objects like nuts and seeds highlights the focus on less typical UAFBs.
Purpose of the Study:
- To investigate the demographics and management strategies for unusual airway foreign bodies (UAFBs) in pediatric patients.
- To analyze the characteristics, clinical presentation, and outcomes of bronchoscopic removal of UAFBs.
Main Methods:
- Retrospective observational study of pediatric patients with UAFBs from 2000-2020.
- Inclusion criteria: bronchoscopic removal of UAFBs, exclusion of common aspirated items.
- Data collected: demographics, foreign body type, clinical/radiological features, management, and outcomes.
Main Results:
- 74 out of 531 children had UAFBs, predominantly males (59/15).
- Common UAFBs included pen caps, whistles, plastic objects, and pins; common sites were left main bronchus, right main bronchus, and trachea.
- Delayed presentation was noted, with chest X-ray aiding diagnosis; 4 children required additional procedures, and 1 mortality occurred.
Conclusions:
- Aspiration of UAFBs in children is a significant concern, often witnessed and more common in boys.
- The left bronchus is a frequent impaction site, and radiographic findings are crucial for diagnosis.
- Bronchoscopic retrieval of UAFBs, while complex, generally yields positive outcomes.
Aim:
The aim is to study the demographics and management of unusual airway foreign bodies (UAFBs) in children.
Materials And Methods:
A retrospective observational study (2000-2020) of children with UAFBs, who underwent bronchoscopic removal. The demographics, types of foreign bodies, clinical and radiological features, management, and outcomes were collated and analyzed. Common foreign bodies, such as nuts, seeds, and vegetable aspirations, were excluded.
Results:
Among 531 children who had bronchoscopic retrieval of airway foreign bodies, 74 (59 males/15 females) had unusual foreign bodies. These included pen caps, whistles, plastic objects, pins, coal piece, stones, clay, pencil, gold ornament, and glass bangle. Thirty-one children presented within 1 day of aspiration, 37 within 1 month and 6 till 6 months. Thirty-nine were below 5 years, and the rest were between 5 and 15 years. Cough, respiratory distress, fever, choking, and noisy breathing were common presentations. Others are stridor, whistling, cyanosis, loss, and change of voice. Chest X-ray showed ipsilateral hyperinflation (23), haziness (21), radio-opaque foreign body (17) and was normal in 14. The left main bronchus, followed by the right main bronchus and trachea, were the sites of impaction. Four children required additional procedures (tracheotomy and thoracotomy). There was one mortality in the study cohort.
Conclusion:
Aspiration of unusual foreign bodies is not uncommon in children. Most aspirations are witnessed and predominant in boys. The left bronchus is the common site of impaction, and X-ray clinches the diagnosis. Presentation is delayed, and bronchoscopic retrieval, though challenging, has favorable outcome.
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