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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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Year : 2002  |  Volume : 7  |  Issue : 4  |  Page : 184-189

Foreign body airway obstructions in children : lessons learnt from a prospective audit


PGIMER, Chandigarh, India

Correspondence Address:
K.L Narasimhan
PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


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ABSTRACT: Aim : To prospectively audit 75 consecutive children referred for foreign body airway obstructions in a 2 year period and to highlight the rarer forms of presentations and morbidity of this procedure. Observations : Of the 75 patients, 63 were boys. Thirty eight (50 percent) of the patients were 1 to 3 years of age. There was a seasonal increase in vegetable foreign bodies during Lohri (winter). Chest X-rays of these patients showed obstructive features in 52 patients. Three patients with foreign bodies in the airway presented with unusual radiological features like pneumothorax, subcutaneous and mediastinal emphysema, and pneumoperitoneum. Five patients presented with refractory bronchial asthma and 2 of them had vegetable foreign bodies in the airway. Two patients with foreign bodies in the airway presented with acute aphonia. One needed a tracheostomy to remove a very large foreign body. Five of the older children had chosked with a whistle dislodged from toys. In 3 patients the bronchoscopy was complicated by attacks of temporary intraoperative hypoxia without sequela due to foreign body in both the bronchi. Two patients needed postoperative ventilatory therapy due to multiple foreign bodies in the respiratory tree and needed more than one attempt at bronchoscopy. Majority of the foreign bodies were vegetable in nature though some toy parts, stones, bones, screws and nails were also found. There were 2 mortalities, 1 due to a missed postoperative pneumothorax resulting in refractory cardiac arrest and the other due to an impacted foreign body at the carina. Conclusions : Children between the age groups 1-3 years are more susceptible to foreign body bronchus though no age group is exempt. The usual presentation is an acute onset of respiratory distress with or without history of choking. One must suspect foreign bodies in the respiratory tract in situations like refractory asthma, bronchiectasis, or hemoptysis without any underlying cause. Uncommon X-ray findings like pneumothorax, pneumomediastinum, and presentations like massive subcutaneous emphysema of sudden onset must make one suspect an underlying foreign body bronchus. The patients must be managed at selected centers with a backup Intensive Care facility. The existing mechanisms of referral must be strengthened with supervised ambulance transportation, preventive education and effective legislation regarding toys.






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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

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