Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the paediatric population: Part 2

The Prevalence and Management of Aerodigestive Foreign Bodies at Rwanda Military Hospital: A Six-years Retrospective Study

Background

Aerodigestive foreign bodies are common issue especially in children, who often place objects in their mouths, leading to inhalation or ingestion. Despite global data on this issue, no comprehensive study has been conducted in Rwanda. This study aimed to assess the prevalence, demographic factors, clinical presentations, diagnostic and management techniques of aerodigestive foreign bodies at Rwanda Military Hospital (RMH).

Methods

This retrospective study reviewed patient records from ENT department of RMH over the period of six years, from January 2017 to December 2022. Data on aerodigestive foreign bodies were extracted from operating room archives and OpenClinic hospital online system, then compiled in Excel spreadsheet, and descriptively analyzed using and SPSS 23.

Results

Among 39,240 patients who consulted the ENT department over the six years, 290 (0.74%) cases of aerodigestive foreign bodies were identified, with male-to-female ratio of 1.34:1. The highest incidence was in children aged 1-3 years (49.66%). Inorganic foreign bodies, especially coins (35.17%), were more common than organic ones. Clinical presentations varied, with 46.21% of cases being asymptomatic, and others showing drooling (17.93%) and dysphagia (9.66%). Chest X-rays were the most frequently used diagnostic tool (49.66%). Esophagoscopy was the primary management method for esophageal cases (45.52%), with bronchoscopy (13.10%) and forceps (34.14%) used for bronchial and nasal cases, respectively.

Conclusion

Aerodigestive foreign bodies, particularly coins, are prevalent in Rwanda, especially among young children and males. This highlights the need for targeted preventive strategies and educational programs to reduce incidence and improve management.

Foreign body aspiration through the eyes of a pediatric pulmonologist: Is it possible to reduce the rate of negative rigid bronchoscopies?

BACKGROUND

Identifying a foreign body aspiration (FBA) still remains a diagnostic difficulty. Moreover, the indications for bronchoscopy in subjects of suspected foreign bodies are not clear. The aim of this study was to evaluate the effectiveness of pediatric pulmonologists in diagnosing FBA.

METHODS

This was a retrospective, single-center study on children who underwent rigid bronchoscopy for suspected FBA. Data on the patients were obtained from the medical records. Patients who had foreign bodies (FB) identified during rigid bronchoscopy were classified as FB positive, and those in whom rigid bronchoscopy did not detect FB were defined as FB negative. Demographic data as well as consultation status with a pediatric pulmonologist were compared between these two groups. Furthermore, the patients were categorized into three groups based on their clinical scores that assessed the likelihood of the presence of FB: low risk, moderate risk, and high risk.

RESULTS

Out of 474 rigid bronchoscopies, 232 (48.9%) detected FB. Consultation by a pediatric pulmonologist was not requested in 388 (81.8%). Out of these 388 patients, 206 (53%) were negative for FB. In terms of FB detection success, there was no difference between individuals who sought pulmonology consultation and those who did not (58.1% vs. 53.1% respectively, p=0.059). However, when the children were categorized based on their risk levels, the incidence of detecting FB among children in low-risk group was 42% when they received consultation from the pulmonology department, whereas this incidence dropped to 5.6% when pulmonology consultation was not sought (p<0.001).

CONCLUSIONS

Consulting a pediatric pulmonologist, particularly for low-risk individuals, might reduce the likelihood of performing unnecessary bronchoscopies. Given that rigid bronchoscopy is an intrusive technique, it is crucial to reduce the number of negative bronchoscopies in order to mitigate complications associated with it.

Tracheobronchial foreign body aspiration in children in Soweto, South Africa: A retrospective descriptive study

Background

Airway foreign bodies are a common cause of accidental death in children. Tracheobronchial foreign body aspiration (FBA) can result in severe immediate and long-term complications if the foreign body is not identified and removed. Little is known about the burden of tracheobronchial FBA in the Soweto area, south of Johannesburg, South Africa. Objectives. To describe the burden and clinical characteristics of tracheobronchial FBA in hospitalised children in a tertiary-level hospital in Johannesburg.

Methods

This was a retrospective, single-centre, descriptive study of children aged <10 years who presented to Chris Hani Baragwanath Academic Hospital from 1 January 2011 to 31 December 2020. Children with FBA were identified from the paediatric pulmonology and paediatric surgery databases using the relevant International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), codes (T17.4 and T17.5). Clinical and radiological data were extracted from medical records and the databases.

Results

Forty-seven children with FBA were identified during the study period. Overall, the incidence of FBA among children aged <10 years of age was 1.42 per 100 000 person-years (95.0% confidence interval 1.04 - 1.88). FBA occurred more commonly in males (66.0%; n=31), and the mean (standard deviation) age at presentation was 68 (28.2) months. Most of the children (42.6%) were in the 7 - <10-year age group, followed by the 5 - <7-year age group (27.7%). Chronic respiratory symptoms were reported in one-third of the children, and a history of witnessed FBA was reported in only 59.6% of cases. Inorganic foreign bodies (n=29; 61.7%) were aspirated more commonly than organic foreign bodies; these included metal objects such as pins or springs (21.3%), toy parts (17.0%), pen or pencil lids/stoppers (12.8%) and plastic objects (6.4%).

Conclusion

Our study highlights the fact that tracheobronchial FBA is prevalent in school-aged children, and public safety campaigns targeted at this age group are warranted. Furthermore, to prevent sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy.

Study synopsis

What the study adds. Our study demonstrated that tracheobronchial foreign body aspiration (FBA) was most prevalent in school-aged children (7 - <10 years of age), which is in contrast to studies that have reported a high prevalence in children aged <3 years. Chronic respiratory symptoms were reported in only a third of the children, and a history of witnessed FBA was reported in only 59.6%. Chest radiographs were normal in a high proportion of cases in which a chest radiograph was done (56.3%). Inorganic foreign bodies were aspirated more commonly than organic foreign bodies.Implications of the findings. Public safety campaigns should be targeted at school-aged children in Soweto, South Africa. Clinicians should investigate children with respiratory symptoms suggestive of FBA, even if a history is not forthcoming. Furthermore, to prevent long-term respiratory sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy.

Foreign Body in the Nasal Cavity: A Case Report

We present a case of a pediatric patient who presented to the emergency room with acute nasal discharge, foul smell, and nasal pain. The patient's mother witnessed her inserting a foreign body into the nasal passage. After thorough examination and diagnostic imaging, a metallic necklace bead was identified as the foreign body lodged in the nasal cavity. The patient was promptly prepared for emergency operating room intervention. The metallic foreign body was successfully extracted without complications using endoscopic equipment and careful manipulation. The patient recovered well, was admitted for one day for observation and supportive care, and was discharged home in excellent condition. Follow-up in the clinic revealed a satisfied patient with no complaints, no septal perforation, and a patent airway.

A Foreign Body Lodged in the Glottis of a Toddler for a Prolonged Time: Anatomical Considerations and Review of the Literature

Our scope is to present the unusual case of an impacted foreign body in a child's larynx for a prolonged period due to recurrent misdiagnosis and review the literature emphasizing the laryngeal foreign body. A toddler girl from a rural region was initially referred to a primary pediatric care center due to a sudden choking episode. The mother made an unsuccessful attempt to pull out a possible foreign body by blind finger sweeping. After 22 days of recurrent misdiagnosis and unsuccessful conservative therapies, the child developed hoarseness of voice and dyspnea during physical exertion. The patient underwent a flexible nasopharyngolaryngeal endoscopy, which observed a foreign body in the glottis, and an emergency microlaryngoscopy. Persistence of laryngeal symptoms in a child with a sudden choking episode should always raise the suspicion of a respiratory tract foreign body impaction. The most appropriate therapeutical approach is rigid bronchoscopy under general anesthesia.

Endoscopic Removal of Sharp-Pointed Foreign Bodies with Both Sides Embedded into the Duodenal Wall in Adults: A Retrospective Cohort Study

PURPOSE

Sharp-pointed FBs with both sides embedded in the duodenal wall are rare. Compared with smooth edged FBs, sharp objects are more likely to be associated with significant adverse events, when penetrating the wall of the digestive tract. The clinical features of patients who experienced sharp-pointed FBs embedded in both sides of the duodenum were retrospectively analyzed, as were the efficacy and safety of endoscopic removal of these FBs.

PATIENTS AND METHODS

This retrospective study included 21 adults with both sides of sharp-pointed FBs embedded into the duodenal wall who were admitted to the Second Xiangya Hospital in China between January 1, 1996, and May 31, 2021. Data associated with the endoscopic removal of these FBs were collected from the electronic medical record system (EMRS) of the hospital.

RESULTS

The incidence rate of duodenal total FBs and FBs embedded in both sides was 8.87% and 1.03%, respectively. The success rate of endoscopic treatment was 100.00% in 124 patients without embedded duodenal FBs and 97.14% in 35 patients with one side embedded duodenal FBs. Of the 21 patients with FBs embedded in both sides of the duodenal wall, endoscopic removal was successful in 85.71% of patients, whereas 14.29% required surgery. FBs removed from these patients included toothpicks in 12; needles in 3; jujube pits in 2; and a chopstick, dentures, fish bones, and chicken bones in one each. Most of these 21 FBs were located in the bulb and descending duodenum, followed by the third part of duodenum.

CONCLUSION

Sharp-edged FBs with both sides embedded in the duodenal wall are rare. Endoscopic removal may be considered as a feasible, safe, and effective method of removing sharp-pointed FBs with both sides embedded in the duodenal wall. And if endoscopic removal is unsuccessful, surgical management can be a secondary option.