Bronchoscopic removal of tracheobroncheal foreign bodies : value of patient history and timing

• Published in: Pediatric surgery international Vol. 17; no. 2-3; pp. 85 - 87
• Main Authors: EMIR, H, TEKANT, G, BESIK, C, ELICEVIK, M, SENYÜZ, O. F, BÜYÜKÜNAL, C, SARIMURAT, N, YEKER, D
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.03.2001; Berlin Springer Nature B.V
• Subjects: Biological and medical sciences; Bronchi; Bronchography; Bronchoscopy; Child; Child, Preschool; Female; Foreign Bodies - diagnosis; Foreign Bodies - etiology; Foreign Bodies - therapy; Humans; Infant; Male; Medical History Taking; Medical sciences; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Suction; Time Factors; Trachea; Human; Bronchoscopy; Removal; Diseases of the trachea; Respiratory disease; Aspiration; Treatment efficiency; Tracheobronchial; Bronchus disease; ENT disease; Complication; Foreign body; Endoscopy; Child; Bibliographic review
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s003830000485

Between 1990 and 1999, 741 bronchoscopic procedures were performed in 698 children, 594 of whom were evaluated for foreign-body aspiration (FBA) (mean age 3.9 years, male:female 287/307). Based on the presenting symptoms, clinical outcome, and complications, two major groups were identified. Group 1 consisted of 438 patients with a definitive history of FBA. Most were admitted soon after the aspiration with sudden onset of symptoms such as coughing, choking, wheezing, and respiratory distress. Group 2 comprised 156 patients with chronic pulmonary infections and/or atelectasis without a definitive history of FBA. The most common radiographic finding was emphysema of one lung in group 1 (61.1%) and pneumonia in group 2 (70%). Among the patients in whom a FB was removed, the percentage of normal radiography was 17%. The FB was identified and removed in 83% of cases in group 1. The complication rate in this group was 9.8%, and all the complications were treated medically. Only 2 patients required intercostal drainage. In group 2, a FB was identified in 25% of bronchoscopic examinations and 17% of the patients developed complications. One of these patients underwent an urgent thoracotomy due to bilateral tension pneumothoraces and 2 required tracheostomies. Patients with a definitive history of FBA, even with a normal physical examination and radiographic findings, must undergo bronchoscopic investigation. Cases with late presentation and chronic pulmonary infection are at high risk. In this group care should be take in determining the indication and timing of bronchoscopy in order to prevent life-threatening complications.