INTERVENTIONAL PULMONOLOGY IN OTHER JOURNALS: Commentary on Selected Publications
Bronchoscopic removal of foreign bodies from children in Bosnia and Herzegovina: experience with 230 patients.
Int J Pediatr Otorhinolaryngol 2001;60:193–6. Brkic F, Delibegovic–Dedic S, Hajdarovic D. ENT Department, Tuzla University Hospital, Tuzla, Bosnia and Herzegovina.
This retrospective analysis of medical records from 230 patients treated between January 1987 and December 1998 included 142 boys (62.2%) and 88 girls (37.8%). The ages of the children were less than 1 year (n = 28, 12.2%), 1 to 2 years (n = 99, 43%), 2 to 3 years (n = 34, 14.8%), 3 to 4 years (n = 19, 8.2%), and more than 4 years (n = 50, 21.7%). A pediatric rigid bronchoscope under general anesthesia was used to identify and extract the foreign bodies (FBs). Analysis of results showed positive bronchoscopic findings in 136 patients (59%). The locations of extracted FBs were the larynx (n = 1, 0.7%), trachea (n = 16, 11.7%), right bronchus (n = 73, 53.7%), left bronchus (n = 41, 30.1%), and in other locations in 5 patients (3.7%). The types of extracted FBs were organic in 114 patients (83.8%), nonorganic in 12 (8.8%), and of an undefinable nature in 10 patients (7.4%). The main types of FBs were pumpkin seed (23.4%), peanut (18.4%), bean (14.6%), walnut (9.2%), and coffee grains (6.8%). The nature of the FB could not be determined in 7.4% of patients, either because the FBs were in a state of disintegration or they were too small. Two children (0.87%) died during the bronchoscopy as a result of cardiac arrest. The authors concluded that aspiration of FBs into the tracheobronchial tree in children carries a high risk, although prompt treatment of survivors is associated with low mortality, and that health care education is the key to prevention. Another publication from Saudi Arabia (Saudi Med J 2000;21:368–71 ) reported results of a retrospective analysis of bronchoscopy for suspected airway FBs over a 3-year period. There were 94 patients (62 male patients) with a mean age of 3.77 years; 85% of the children were younger than 5 years of age. FBs were removed from 60 patients (64%). Six (10%) did not have any definite history, whereas 15 patients (21%) with a definite history of FB aspiration had negative bronchoscopy. An aspirated Fis-Fis (alfalfa, Lucerne) seed accounted for more than one third of all FBs. These authors concluded that a negative history, clinical examination, and chest radiograph do not necessarily exclude aspirated FBs. Most bronchoscopic extractions of FBs, if performed appropriately, result in minimal to mild complications and negligible or no mortality related to the bronchoscopy itself. The mortality rate of 0.87% during bronchoscopy described by Brkic et al. should remind us that inhalation of an FB into the tracheobronchial tree can be a very serious problem, sometimes with a fatal outcome. Aspiration of airway FBs remains among the most common causes of death in children younger than 5 years of age. Unless a child with respiratory symptoms raises the index of suspicion in the mind of the attending physician, the diagnosis can be missed and the child may face marked morbidity and mortality. Clearly, a clear history of FB aspiration or witnessed aspiration of FB is by itself indications for bronchoscopy. Bronchoscopy is the most effective diagnostic and therapeutic modality to prevent complications related to neglected FB aspiration.