Management of foreign body aspiration in infancy and childhood - A life-threatening problem

Abstract

It is well known that young children have tendency to place objects in their mouths, frequently leading to aspiration of foreign bodies (FBs) into the tracheobronchial tree (TBT). The patient group comprised 596 patients with a history of suspected aspiration of FBs into the TBT who were bronchoscoped for diagnosis and treatment. There were 306 male (51.3%) and 290 female (48.7%) patients, with a mean age of 2.4 years (range 3 months-13 years). Sunflower seeds and hazelnuts were the most common FBs that were extracted using an open-tube rigid bronchoscope (Storz, Germany) and suitable coaxial forceps (Storz, Germany). Patients admitted within 48 hours following the aspiration numbered 341 (57.2%). The distribution of FBs between the right and left lung and trachea was 53, 37 and five percent, respectively. The aspirated material was visible on the chest x-ray in only 10 percent cases, which facilitated in making the diagnosis. Despite a history of aspiration, bronchoscopy was negative in 21 (3.4%) of the cases. Thoracotomy and subsequent bronchotomy was the treatment of choice in seven (1.5%) and lobectomy in two (0.3%) cases. Cardiorespiratory arrest was observed in five (0.8%) cases, three of whom (0.5%) died during bronchoscopy (2 cases) or thoracotomy (1 case). In conclusion, patients with FB aspiration are rapidly recognized from their histories and easily treated by bronchoscopy and extraction of the aspirated foreign body. A high index of suspicion is crucial for early diagnosis. However, education is the best preventive measure for decreasing the incidence of this problem.