Bronchotomy as a Safe and Feasible Alternative to Failed Bronchoscopic Removal of Foreign Body Inhalation in Pediatrics. A Seven-Year Review

Abstract

Background: Aspiration of foreign body is popular in pediatric age group and is considered as an important cause of respiratory distress and chocking in these children. Management strategies are different according to the mode of presentation. This study aims to assess the efficacy of rigid bronchoscopy and the role of bronchotomy as a safe alternative for failed removal of inhaled foreign body. Methods: We enrolled 254 patients with foreign body aspiration (FBA) up to 14 years old in a retrospective observational study. Our patients were reviewed from the Cardiothoracic Surgery Department and cases referred from Otorhinolaryngology Department, Menoufia University Hospital between June 2010 and July 2017. Using jet ventilation technique, foreign body was removed by the rigid bronchoscopy with either extracting forceps or postural drainage. Surgical interference such as bronchotomy needed in distally impacted foreign bodies (FBs). Results: Our study included 254 patients prepared for bronchoscopic FBs extraction. Most of cases (68.8%) presented early within first week (174 cases). No FBs detected in 44 cases by rigid bronchoscopy, although it was successful in 176 (69.5%) cases with nonimpacted inhaled FBs. 14 cases only needed postural drainage due to inaccessible FBs, another 12 cases failed to extract FB with rigid bronchoscopy but they were managed with flexible bronchoscopy. Bronchotomy was needed for impacted FBs in eight cases (3%). Conclusion: This study's findings support that rigid bronchoscopy is the gold standard in the diagnosis and removal of foreign body aspirations in pediatrics, but rigid bronchoscopy demonstrated less capability in the diagnosis and removal of small distally located foreign bodies. Bronchotomy is safe and effective alternative.

Video-assisted thoracoscopic surgery involving a bronchotomy in the removal of a bronchial foreign body: A novel case report

“…Indications for bronchotomy include the failure to remove the foreign body despite repeated attempts, due to immobility, with or without distal bronchial placement. Elaziz et al have reported on eight cases of thoracotomy and bronchotomy [ 13 ]. They have concluded that bronchotomy is a safe and effective alternative to difficult and failed bronchoscopic extractions [ 13 ].…”

“…Elaziz et al have reported on eight cases of thoracotomy and bronchotomy [ 13 ]. They have concluded that bronchotomy is a safe and effective alternative to difficult and failed bronchoscopic extractions [ 13 ]. In the present case, we performed a bronchotomy, as opposed to a right lower lobectomy, to remove the bronchial foreign body without sacrificing the functioning of the lung parenchyma.…”

Surgical retrieval and successful bronchial repair for impacted foreign body: a case report

“…Elaziz, M.A., et al [2] have also performed bronchotomy, but their experience was limited to pediatric cases only. Aihole JS et al [3] reported their experience, but it was also limited to pediatric cases only.…”

“…Author details 1 CTVS Department, AIIMS Rishikesh, Rishikesh 249203, India. 2 Pulmonary Medicine Department, AIIMS Rishikesh, Rishikesh 249203, India.…”