Introduction: Foreign body aspiration is not uncommon in children. It can be associated with significant morbidity and mortality. This study aims to determine and analyze the characteristics of local pediatrics airway foreign body (FB) aspiration. Methods: A retrospective study of medical records from KK hospital (1997-2010) is done. Patient demographics, clinical/investigative findings, duration of hospitalization and complications are analyzed. Results: The sample consisted of 26 patients (eight months - 13 years of age), who underwent rigid bronchoscopy for FB removal over the last 13 years. Seventy-seven percent were three years of age or younger. Peak incidence (61.6%) was at one to two years of age. Nineteen were males and seven were females. The top three clinical presentations were: cough (61.5%), choking (46.2%) and wheezing (42.3%). Decreased air entry (34.6%), tachypnea (26.9%) and no significant findings (23.1%) were the most common features on physical examination. The most common radiographic findings were consolidation (30.8%), presence of a foreign body (23.1%) and no abnormality (23.1%). Aspiration was primarily into the right main bronchus (38.5%), and 61.5% of the FB was organic in nature [principally peanuts (38.5%)]. Mean hospitalization duration was three days. Delayed diagnose in three cases were secondary to mis-diagnoses as croup (n = two) and respiratory tract infection (n = one). Complications were noted in eight cases (30.8%). There was no mortality. Conclusion: High index of suspicion is required in diagnosing airway FB. Physician’s diagnostic acumen is vital in prompt successful treatment. Heightening public’s awareness is the key to prevention of pediatrics FB aspiration.
KeywordsAirwayForeign BodyChildren
R. M. Esclamado and M. A. Richardson, “Laryngotracheal Foreign Bodies in Children. A Comparison with Bronchial Foreign Bodies,” American Journal of Diseases of Children, Vol. 141, No. 3, 1987, pp. 259-262.
T. Hilliard, R. Sim, M. Saunders, S. L. Hewer and J. Henderson, “Delayed Diagnosis of Foreign Body Aspiration in Children,” Emergency Medicine Journal, Vol. 20, No. 1, 2003, pp. 100-101. doi:10.1136/emj.20.1.100
F. Karakoc, E. Cakir, R. Ersu, Z. S. Uyan, B. Colak, B. Karadag, G. Kiyan, T. Dagli and E. Dagli, “Late Diagnosis of Foreign Body Aspiration in Children with Chronic Respiratory Symptoms,” International Journal of Pediatric Otorhinolaryngology, Vol. 71, No. 2, 2007, pp. 241-246. doi:10.1016/j.ijporl.2006.10.006
S. Cohen, H. Pine and A. Drake, “Use of Rigid and Flexible Bronchoscopy among Pediatric Otolaryngologists,” Archives of Otolaryn-gology—Head & Neck Surgery, Vol. 127, No. 5, 2001, pp. 505-509.
C. E. Skoulakis, P. G. Doxas, C. E. Papadakis, E. Proimos, P. Christodoulou, J. G. Bizakis, G. A. Velegrakis, D. Mamoulakis and E. S. Helidonis, “Bronchoscopy for Foreign Body Removal in Children. A Review and Analysis of 210 Cases,” International Journal of Pediatric Otorhinolaryngology, Vol. 53, No. 2, 2000, pp. 143-148. doi:10.1016/S0165-5876(00)00324-4
H. K. Tan, K.Brown, T. McGill, M. A. Kenna, D. P. Lund and G. B. Healy, “Airway Foreign Bodies (FB): A 10-Year Review,” International Journal of Pediatric Otorhinolaryngology, Vol. 56, No. 2, 2000, pp. 91-99. doi:10.1016/S0165-5876(00)00391-8
R. Altkorn, X. Chen, S. Milkovich, D. Stool, G. Rider, C. M. Bailey, A. Haas, K. H. Riding, S. M. Pransky and J. S. Reilly, “Fatal and Non-Fatal Food Injuries among Children (Aged 0 - 14 Years),” International Journal of Pediatric Otorhinolaryn-gology, Vol. 72, No. 7, 2008, pp. 1041-1046. doi:10.1016/j.ijporl.2008.03.010
P. F. Bittencourt, P. A. Camargos, P. Scheinmann and J. de Blic, “Foreign Body Aspiration: Clinical, Radiological Findings and Factors Associated with Its Late Removal,” International Journal of Pediatric Otorhinolaryngology, Vol. 70, No. 5, 2006, pp. 879-884. doi:10.1016/j.ijporl.2005.09.024
J. Roda, S. Nobre, J. Pires, M. H. Estevao and M. Felix, “Foreign Bodies in the Airway: A Quarter of A Century’s Experience,” Revista Portuguesa de Pneumologia, Vol. 14, No. 6, 2008, pp. 787-802.
X. Latifi, A. Mustafa and Q. Hysenaj, “Rigid Tracheo- bronchoscopy in the Management of Airway Foreign Bodies: 10 Years Experience in Kosovo,” International Journal of Pediatric Otorhinolaryngology, Vol. 70, No. 12, 2006, pp. 2055-2059. doi:10.1016/j.ijporl.2006.07.017
F. Oguz, A. Citak, E. Unuvar and M. Sidal, “Airway Foreign Bodies in Childhood,” International Journal of Pediatric Otorhi-nolaryngology, Vol. 52, No. 1, 2000, pp. 11-16. doi:10.1016/S0165-5876(99)00283-9
K. Mantel and I. Butenandt, “Tracheobronchial Foreign Body Aspiration in Childhood,” European Journal of Pediatrics, Vol. 145, No. 3, 1986, pp. 211-216. doi:10.1007/BF00446068
A. M. Shivakumar, A. S. Naik, K. B. Prashanth, K. D. Shetty and D. S. Praveen, “Tracheobronchial Foreign Bodies,” The Indian Journal of Pediatrics, Vol. 70, No. 10, 2003, pp. 793-797. doi:10.1007/BF02723797
C. Y. Chiu, K. S. Wong, S. H. Lai, S. H. Hsia and C. T. Wu, “Factors Predicting Early Diagnosis of Foreign Body Aspiration in Children,” Pediatric Emergency Care, Vol. 21, No. 3, 2005, pp. 161-164.
J. E. B.Fontoba, C. Gutierrez, J. Lluna, J. J. Vila, J. Poquet and S. Ruiz-Company, “Bronchial Foreign Body: Should Bronchoscopy Be Performed in All Patients with A Choking Crisis?” Pediatric Surgery International, Vol. 12, No. 2-3, 1997, pp. 118-120. doi:10.1007/BF01349976
R. E. Morley, J. P. Lu-demann, J. P. Moxham, F. K. Kozak and K. H. Riding, “Foreign Body Aspiration in Infants and Toddlers: Recent Trends in British Columbia,” The Journal of Otolaryngol-ogy, Vol. 33, No. 1, 2004, 2004, pp. 37-41. doi:10.2310/7070.2004.00310
N. E. Wiseman, “The Diagnosis of Foreign Body Aspiration in Childhood,” Journal of Pediatric Surgery, Vol. 19, No. 5, 1984, pp. 531-535. doi:10.1016/S0022-3468(84)80097-4
M. Tomaske, A. C. Gerber, S. Stocker and M. Weiss, “Tracheobronchial Foreign Body Aspiration in Children-Diagnostic Value Of Symptoms and Signs,” Swiss Medical Weekly, Vol. 136, No. 33-34, 2006, pp. 533-538.
H. David and D. H. Darrow, “Pediatric Otolaryngology. Chapter 90: Foreign Bodies of the Larynx, Trachea, and Bronchi,” 4th Edition, Saunders (Elsevier Science), Philadelphia, 2003.
B. C. Becker and T. G. Nielsen, “Foreign Bodies in the Air-ways and Esophagus in Children,” Ugeskrift for L?ger, Vol. 156, No. 30, 1994, pp. 4336-4339.
J. T. Zerella, M. Dimler, L. C. McGill and K. J. Pippus, “Foreign Body Aspiration in Children: Value of Radiography and Compli-cations of Bronchoscopy,” Journal of Pediatric Surgery, Vol. 33, No. 11, 1998, pp. 1651-1654. doi:10.1016/S0022-3468(98)90601-7
A. B. Silva, H. R. Muntz and R. Clary, “Utility of Conventional Radio-graphy in the Diagnosis and Management of Pediatric Air-way Foreign Bodies,” Annals of Otology, Rhinology and Laryngology, Vol. 107, No. 10, 1998, pp. 834- 838.
S. J. Hong, H. W. Goo and J. L. Roh, “Utility of Spiral and Cine CT Scans in Pediatric Patients Suspected of Aspirating Radiolucent Foreign Bodies,” Otolaryngology Head and Neck Surgery, Vol. 138, No. 5, 2008, pp. 576- 580. doi:10.1016/j.otohns.2007.12.039
F. L. Tang, M. Z. Chen, Z. L. Du, C. C. Zou and Y. Z. Zhao, “Fibro-bronchoscopic Treatment of Foreign Body Aspiration in Children: An Experience of 5 Years in Hangzhou City, China,” Journal of Pediatric Surgery, Vol. 41, No. 1, 2006, pp. e1-e5. doi:10.1016/j.jpedsurg.2005.10.064
S. P. Yadav, J. Singh, N. Aggarwal and A. Goel, “Airway Foreign Bodies in Children: Experience of 132 Cases,” Singapore Medical Journal, Vol. 48, No. 9, 2007, pp. 850-853.
J. C. Fraga, A. F. Pires, M. Komlos, E. E. Takamatu, L. G. Camargo and F. H. Contelli, “Bronchoscopic Removal of Foreign Body from Airway through Tracheotomy or Tracheostomy,” Jornal de Pediatria, Vol. 79, No. 2003, pp. 369-372. doi:10.1590/S0021-75572003000400017
V. Erikci, S. Karacay and A. Arikan, “Foreign Body Aspiration: A Four-Years Experience,” Ulusal Travma ve Acil Cerrahi Dergisi, Vol. 9, No. 1, 2003, pp. 45-49.
A. Pinto, M. Scaglione, F. Pinto, G. Guidi, M. Pepe, B. Del Prato, R. Grassi and L. Romano, “Tracheobronchial Aspiration of Foreign Bodies: Current Indications for Emergency Plain Chest Radiography,” La Radiologia Medica, Vol. 111, No. 4, 2006, pp. 497-506. doi:10.1007/s11547-006-0045-0
F. Brkic and S. Umihanic, “Tracheobronchial Foreign Bodies in Children. Experience at ORL Clinic Tuzla, 1954-2004,” International Journal of Pediatric Otorhinolaryngolog, Vol. 71. No. 6, 2007, pp. 909-915.
L. Mu, P. He and D. Sun, “Inhalation of Foreign Bodies in Chinese Children: A Review of 400 Cases,” Laryngoscope, Vol. 101, No. 6, 1991, pp. 657-660. doi:10.1288/00005537-199106000-00014
A. Ku-gelman, R. Shaoul, M. Goldsher and I. Srugo, “Persistent Cough and Failure to Thrive: A Presentation of Foreign Body Aspiration in a Child with Asthma,” Pediatrics, Vol. 117, No. 5, 2006, pp. e1057-e1060. doi:10.1542/peds.2005-2196
M. Sirmali, H. Turut, E. Kisacik, G. Findik, S. Kaya and I. Tastepe, “The Relationship between Time of Admittance and Complications in Paediatric Tracheobronchial Foreign Body Aspiration,” Acta Chirurgica Belgica, Vol. 105, No. 6, 2005, pp. 631-634.
A. Martinot, M. Closset, C. H. Marquette, V. Hue, A. Deschildre, P. Ramon, J. Remy and F. Leclerc, “Indications for Flexible versus Rigid Bronchoscopy in Children with Suspected Foreign-Body Aspiration,” American Journal of Respiratory and Critical Care Medicine, Vol. 155, No. 5, 1997, pp. 1676-1679.
P. C. Fitzpatrick and J. L. Guarisco, “Pediatric Airway Foreign Bodies,” The Journal of the Louisiana State Medical Society, Vol. 150, No. 4, 1998, pp. 138-141.
Z. J. Chen, F. G. Zhu, N. K. Zhang, and J. J. Chen, “Therapeutic Experience from 1428 Patients with Pediatric Tracheobronchial Foreign Body,” Journal of Pediatric Surgery, Vol. 43, No. 4, 2008, pp. 718-721. doi:10.1016/j.jpedsurg.2007.10.010
M. Asif, S. A. Shah, F. Khan and R. Ghani, “Foreign Body Inhala-tion-Site of Impaction and Efficacy of Rigid Bronchoscopy,” Journal of Ayub Medical College Abbot- tabad, Vol. 19, No. 2, 2007, pp. 46-48.
J. A. Nakhosteen, “Tracheobronchial Foreign Bodies,” Euro- pean Respiratory Journal, Vol. 7, No. 3, 1994, pp. 429-430. doi:10.1183/09031936.94.07030429
M. Fraga Ade, M. C. Reis, M. P. Zambon, I. C. Toro, J. D. Ribeiro and E. C. Baracat, “Foreign Body Aspiration in Children: Clinical Aspects, Radiological Aspects and Bronchoscopic Treatment,” The Jornal Brasileiro de Pneumologia, Vol. 34, No. 2, 2008, pp. 74-82.
R. E. Black, D. G. Johnson and M. E. Matlak, “Bronchoscopic Removal of Aspirated Foreign Bodies in Children,” Journal of Pediatric Surgery, Vol. 29, No. 5, 1994, pp. 682-684. doi:10.1016/0022-3468(94)90740-4
G. M. Zaytoun, P. W. Rouadi and D. H. Baki, “Endoscopic Management of Foreign Bodies in the Tracheobronchial Tree: Predictive Factors for Complications,” Otolaryngology— Head and Neck Surgery, Vol. 123, No. 3, 2000, pp. 311-316. doi:10.1067/mhn.2000.105060
D. W. Vane, J. Prit-chard, C. W. Colville, K. W. West, H. Eigen and J. L. Grosfeld, “Bronchoscopy for Aspirated Foreign Bodies in Children. Experience in 131 Cases,” Archives of Surgery, Vol. 123, No. 7, 1988, pp. 885-888. doi:10.1001/archsurg.1988.01400310099017
N. Despres, A. Lapointe, M. C. Quintal, P. Arcand, C. Gi-guere and A. Abela, “3-Year Impact of A Provincial Choking Prevention Program,” The Journal of Otolaryngy, Vol. 35, No. 4, 2006, pp. 216-221. doi:10.2310/7070.2005.0014
N. Sadan, A. Raz and B. Wolach, “Impact of Community Educational Pro-grammes on Foreign Body Aspiration in Israel,” European Journal of Pediatrics, Vol. 154, No. 10, 1995, pp. 859-862. doi:10.1007/BF01959798