Inhalation of foreign bodies in chinese children: A review of 400 cases

Abstract

A retrospective review of 400 Chinese children who had inhaled foreign bodies was undertaken. There has been a yearly increase in the total number of cases of airway foreign bodies removed in our hospital. Fifty-eight percent of the children presenting were from the countryside; 42% were townspeople. Approximately 90% of the patients were under 3 years of age, with the peak incidence of foreign body inhalation occurring between 1 and 2 years of age (57.8%). The male-female ratio was about 1.2:1. About 95% of the removed foreign bodies were organic in origin. The majority of the foreign bodies were found most often in the right bronchial tree (46%). A positive history of foreign body inhalation was obtained in 98% of the cases. Twenty-eight percent of the children presented at the hospital within 24 hours, 71% within 1 week, and 29% more than 1 week after inhaling the foreign body. The most common presenting symptoms of laryngotracheal foreign bodies were cough, wheezing, dyspnea, and hoarseness; those of bronchial foreign bodies were cough, wheezing, decreased air entry, and rhonchi. More than two-thirds of the children with larygotracheal foreign bodies had normal x-ray findings. The most common fluoroscopic findings in those children with bronchial foreign bodies were mediastinal shift (36.8%), obstructive emphysema (35.7%), and normal findings (35%). A total of 348 (87%) bronchial foreign bodies were removed by rigid bronchoscopy (81%), rod-lens bronchoscopy (5%), and spontaneous expulsion (1%); 52 (13%) laryngeal and tracheal foreign bodies were removed by direct laryngoscopy (12%) and tracheotomy (1%). A single endoscopic procedure successfully removed 92.5% of 400 foreign bodies detected in the airways. One child died during bronchoscopy, for a mortality rate of 0.25%.

Aspiração de corpo estranho através de traqueotomia: descrição de um caso

“…The reason for a relatively small percentage (about 0.60% of foreign bodies) is a result of the protection of airways with epiglottis, arytenoids and coughing reflex. The main sites for impaction are, in order, right source bronchus, left source bronchus and trachea 1-3. According to the literature [1][2][3][4][5] , most of the cases happen up to 3 years of age, with slight predominance of male. The most frequent aspirated objects are seeds, including, among others, beans, rice and peanuts, and small metal and plastic objects, such as fragments or parts of toys.…”

“…In our service, we have had uncommon cases, such as the patient that aspirated ammunition when he was embraced by his daughter while cleaning the gun and holding the bullet in his mouth. However, the history is not always clear and if in doubt, we should always perform exploratory bronchoscopy [1][2][3][4] .…”

“…Wheezing and snoring in patients without previous history of bronchial asthma should be warning signs. Suprasternal draught may be present in cases of respiratory failure, as well as cyanosis in more extreme cases 1,3,4 .…”

“…The literature is unanimous to say that complications normally take place when it takes too long to intervene, normally because of diagnostic uncertainty 1,3,4,5 . The complications include pneumonia, pneumo-mediastinum, pneumothorax, mediastinitis, respiratory failure and death 1,6 . Bronchoscopy is a relatively simple procedure in most cases, and we should emphasize the need of appropriate training practice and the right material (rigid bronchoscope of different sizes and clamps for bronchial foreign bodies) 7,8 .…”

Bronchial foreign body: A case report

“…Its sequelae range from choking and fatal asphyxiation to a chronic forgotten episode that may mimic chronic and recurrent chest infections, with a spectrum of severity in between (3), Complications rate has decreased in the last two decades (4) • Complications depend on site, size, shape, nature and duration of the foreign body especially in the early phase (5) The majority of fatalities due to foreign body aspiration are caused by round, smooth objects that occlude the airway either supra or infraglottic (5) . On the other hand, smaller objects that pass this site tend to lead to the late complications.…”