Publications
Unusual Airway Foreign Bodies in Children: Demographics and Management
Sumona Bose , Attibele Mahadevaiah Shubha ABSTRACT
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. Airway foreign bodies aspirations are life-threatening, requiring a high index of suspicion, prompt recognition, and early management to prevent morbidity and mortality. Foreign-body aspiration (FBA) is a common cause of hospitalization in healthy children aged 1–3 years.[1] It is one of the leading causes of accidental infantile deaths and fourth among preschool children (≤5 years).[2] The age predisposition is postulated to be due to (i) immature neural mechanisms, (ii) poor chewing ability, (iii) lack of posterior dentition, (iv) tendency to explore objects by mouth, and (v) indulging in multiple activities at the time of eating. Common foreign bodies aspirated are organic, often peanuts. However, various unusual objects are aspirated and pose both diagnostic and therapeutic dilemmas. Thus far, none of the studies have analyzed unusual FBAs separately and highlighted their unique differences. Here, we aim to study the demographics and management of unusual AFBs (UAFBs) in children. MATERIALS AND METHODS
A retrospective observational study over 20 years (2000–2020) of all children with UAFBs, who underwent bronchoscopic removal at a tertiary care hospital. The demographic details, types of unusual 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.
