Tracheobronchial Foreign Body Aspirations: Lessons Learned From a 10-year Audit

Mahajan, Jai Kumar MCh; Rathod, Kirti K. MS; Bawa, Monika MCh; Rao, Katragadda L.N. MCh, FACS

Journal of Bronchology & Interventional Pulmonology:
doi: 10.1097/LBR.0b013e31822386a4
Original Investigations
Abstract

Background : Foreign body aspirations (FBA) in the tracheobronchial tree must be suspected in children who present with a witnessed history of choking or respiratory distress of sudden onset and asymmetric breath sounds, even in the absence of pathognomonic radiographic findings. This study reviews our experience with a variety of FBA and outlines the salient differences in the literature.

Methods : One hundred eighty-four consecutive children with a history suggestive of FBA undergoing bronchoscopy over a period of 10 years were reviewed. In all of the cases, rigid bronchoscopy was performed under general anesthesia using a Storz ventilating bronchoscope with the aid of optical forceps.

Results : In 166 (90.21%) patients, a foreign body (FB) was discovered, whereas in 18 (9.78%) children, no FB could be found. The highest incidence of FBA (126/166, 75.9%) was found in the age group between 1 and 5 years. FBA of organic origin were more common (77.77%) in the younger patients (<3 y) as compared with the older patients (12.23%, >3 y) (P<0.0001). The radiographs were suggestive in 90% of the children >5 years of age (P<0.0063). Seven patients had a delay in the diagnosis and were being treated for various medical ailments. The incidence of FBA was almost double (64.83%) during the winter months as compared with rest of the year (34.17%). Pen cap aspirations were seen in 7 patients, and 6 of them could be extracted successfully with bronchoscopy. Two patients died.

Conclusions : Bronchoscopy can be a life-saving procedure and is safe even when no FB is found. The parameters of the history of witnessed choking, respiratory distress of sudden onset, and the asymmetric breath sounds are used in the decision making to perform a bronchoscopy. Radiographs are less helpful in younger patients. Nonorganic FBA is more common in older children. There may be seasonal variations and more attention should be given to small children during the times of high incidence.

Author Information

Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Disclosure: No funding was received for this study. The authors have no competing interests or conflicts of interest to disclose.

Reprints: Jai Kumar Mahajan, MCh, Department of Pediatric Surgery, PGIMER, Chandigarh (e-mail: jkmahajan@gmail.com).

Received December 6, 2010

Accepted April 21, 2011

© 2011 Lippincott Williams & Wilkins, Inc.