Management of tracheobronchial foreign bodies-experience of cardiothoracic department of cardiology institute

Abstract

Background

We report our experience of 3 years in the management of tracheobronchial foreign bodies in our department of cardiothoracic surgery.

Materials and methods

This is a retrospective study of confirmed tracheobronchial Foreign Body (FB) between May 2006 and October 2009. Patients with severe respiratory distress and pneumonia were electively ventilated for 48 h before any intervention. Flexible fibreoptic bronchoscopy was performed for the initial diagnosis and assessment of tracheobronchial FB. Once confirmed removal was done by rigid bronchoscopy. Patient was kept in intensive surgical unit for 2–4 h with chest X-ray repeated at arrival and after 24 h. Majority of patients were discharged the next day with advice to come for follow up after 1 week. Chest X ray was done at 1st follow up depending on which further follow up treatment course was planned.

Results

The study consists of 50 patients. The most common age group was 7 months to 18 months. There were 34 males and 16 females. The most common symptom was cough and wheezing which was present in all the patients. 1 patient was in severe respiratory distress. This child was electively ventilated for 48 h before intervention.Obstructive emphysema was the most common radiological finding. 42 patients had foreign body lodged in Right Main Bronchus (RMB). Two patients required thoracotomy for removal of foreign body.The majority of foreign bodies in our cases were organic like ground nut seeds, chana and imli seed. Follow up was uneventful.

Conclusions

In conclusion, diagnosis of tracheobronchial FB depends on a high index of suspicion. Flexible fibreoptic bronchoscopy is the diagnostic investigation of choice for initial evaluation and rigid bronchoscopy is the standard for removal of foreign body.Thoracotomy may be life saving in endoscopically non retrievable foreign bodies. Once identified, FB should be removed as early as possible but one should not rush overlooking the general condition of the patient.