FOREIGN BODIES IN AIRODIGESTIVE TRACT

19/10/22Prof. Abdulsalam Y Taha1

Let me take you all to your childhood. I am sure you must have heard the story

of snow white and seven dwarfs, in which an apple piece lodges in the throat of princess due to the evil works of the witch, and princess comes back to

life only when that apple piece is dislodged from the throat by the prince.

I think that if that prince wouldn’t have

been a prince, he would definitely have been a very good bronchoscopist .

Foreign Bodies in Aero-digestive Tract

Foreign Bodies in the Foreign Bodies in the Airo-Airo-

Digestive TractDigestive Tract

ByBy Prof. Abdulsalam Y TahaProf. Abdulsalam Y Tahahttps://sulaimaniu.academia.edu/AbdulsalamTaha

•Unit of Thoracic SurgeryUnit of Thoracic Surgery•Sulaimania Teaching HospitalSulaimania Teaching Hospital


https://sulaimaniu.academia.edu/AbdulsalamTaha

https://sulaimaniu.academia.edu/AbdulsalamTaha

NOTE! •I have presented this lecture at October 7th 2004 in the Ministry of Health/ lecture hall few months after establishment of our Broncho-Esophagoscopy Unit in Sulaimania Teaching Hospital/Sulaimania/Region of Kurdistan/Iraq. It has, therefore, both a scientific and historical values.

19/10/223 Prof. Abdulsalam Y Taha

INTRODUCTIONThoracic and cardiovascular surgical department in Suleimani Teaching Hospital is about to complete its first year. Thus it is in its infancy.However, it has become one of the very active and busy departments inthe hospital.

Our bronchoscopy unit began in December 2003.

By now, more than 125 flexible bronchoscopies and more than 60 rigidBronchoscopies and oesophagoscopies have been performed for differentindications.

We have faced many difficulties to obtain the necessary instruments forpaediatric bronchoscopy .

Once these equipments were obtained, paediatric bronchoscopy and

oesophagoscopy began in May 2004.


Patients (children and adults) were referredto our unit with aspirated or ingested foreignbodies.

Over 4 month period at least 40 patients withdifferent foreign bodies were managed in ourunit with excellent outcome.

Many patients unfortunately were not registeredas they returned back to their referring doctorafter endoscopy.

In this seminar, some of these cases will bepresented for the sake of demonstration.19/10/225 Prof. Abdulsalam Y Taha

M ales 17Fem ales 12Children 28< 1 year 9 1- 5 year 14 6 year and above 5 Adult (50 year old) 1Positive bronchoscopy 18Negative bronchoscopy 11Site of Im pactionLarynx 1Trachea 2Right bronchial tree 9Left bronchial tree 6Type of FBPeanut 5W aterm elon seed 5Rubber piece 1Sunflower seed 5Denture 1Plastic whitsel 1Duration of InhalationFew hours 1Few days 7W eeks to m onths 10Outcom e ExcellentTotal 29

AspiratedForeignBodies


Foreign Bodies in O esophagus M ales 13Fem ales 4Adults 12Children 5 Positive oesophagoscopy 11Negative oesophagoscopy 6Site of Im pactionHypopharynx 1Upper oesophagus 8M id- thoracic oesophagus 1Lower thoracic oesophagus 1Type of FBM etalic 4Bone 4M eat 1Denture 1Plastic m aterial 1 Total 17Outcom e Excellent


Arrangements should be made for early removal in OT as edema and mucosal swelling will make retrieval more difficult. As is often the case in

medicine, the decision to use flexible or rigid instrumentation depends on a variety of things including the availability of equipment, experience of personnel, the age and medical status of the child, nature of the object

and length of time since impaction. Ideally, a coordinated team of surgeons and physicians trained in both rigid and flexible endoscopy, who can

perform the removal the foreign body in one procedure should undertake this work.


• For removal of foreign body with fibreoptic bronchoscope, a fogarty balloon catheter can be used. This is a schematic drawing showing the fogarty catheter passing through a hole in the foreign body.Once it passes through the fb, the balloon is inflated and the foreign body is then dragged out.


• Flexible bronchoscopic view of a large foreign body (mini light bulb lodged in the right main bronchus of a 7-year-old boy (left, A).

• The ureteral stone basket inserted through the 1.2-mm working channel of the bronchoscope has grasped the foreign body (right, B),

• Proximal portion of the foreign body is pulled in to distal end of the endotracheal tube by the flexible bronchoscope (right, C).

• Once the foreign body is thus secured,the entire apparatus (endotracheal tube, flexible bronchoscope, and basket with the foreign body in it) is removed en masse from the airways.


• The flexible bronchoscope is introduced through an aid adapter and a laryngeal mask airway. Forceps are introduced through the flexible bronchoscope channel. The ambu bag supplied with oxygen, helps ventilate the patient during the procedure.


• The newer optical grabbing forceps contain an integrated telescope and can be passed through most rigid ventilating bronchoscopes (size 3.5 & above). They give a supeb view of trachea and the main stem bronchi. This enables the operator to grasp an object such as a peanut under direct vision. These optical instruments will make the management of tracheobronchial foreign bodies much easier and safer, although presently very few institutions have this instrument.


M. N. F. A 78 YR EDENTULOUS MAN


A MAN OF 35


A BOY OF 17 MONTHS


D.Y.K: two and a half yr old boyIngestion of metallic foreign body


A. M. H. A BOY OF 2


M. F. AN EDENTULOUS MAN OF 82: INGESTION OF A BIG MEAT BOLOUS


A TEENAGER INJESTED A BONE BUT REFUSED OESOPHAGOSCOPY


AN EDENTULOUS LADY OF 70: SUSPISION OF CHICKEN BONE INJESTION.


A GIRL OF 17 COMMITTED A SUCIDE BY INGESTION OF 7 RAZORS !


One and a half yr old boy with respiratory distress


Pectus Excavatum


19 months old girl with aspirated sunflower seed


A 2 yr old boy: watermelon seed inhalation of few days duration


A 4 yr old boy suspected to have aspirated FB


A five and a half yr old boy: non-resolved coughof 40 days duration


19 months old girl19/10/2270 Prof. Abdulsalam Y Taha

A. A: a 20 months oldgirl with RLL atelectasis due to

aspirated sunflower seed of 2 m duration


Post-bronchoscopy chest radiograph19/10/2275 Prof. Abdulsalam Y Taha

A. M: a 50 yr old man

with intra-laryngeal denture


Shuaib 4 yr old boy: ingestion of a metallic spring



A 24 days old neonate!

Normal CTHRCTReconstructionVirtual ScopyIf x ray is unsuccessful in localizing the FB, and FB is strongly suspected, next option is computed tomography. Today Ct offers not only the option of normal and high resolution CT, but also of 2D reconstruction and virtual scopy.


These are photographs of 2D CT reconstruction.

Altough these particular

photographs are not of FB

obstruction, but they do clearly

show, how clearly this technique can

localize any obstruction in normal airway.


These are the photographs of Virtual imaging or virtual endoscopy. In this images of all 3

dimensions are combines with a computer software and is used to create 3 D images similar to actual endoscopy. Advantage is that not only it is non invasive but ou can

actually naviagate or do scopy beyoynd the actual

obstruction as well.

In this lower image you can easily see the c

shaped tracheal rings and distal carina


Next among the investigations is MRI. Can give

better sequences especially in relation to

radiolucent and vegetative Fbs.

Also useful for better

characterization of lesions resulting

as long term sequelae of fb

obstruction.19/10/22Prof. Abdulsalam Y Taha104

Aspirated and ingested foreign bodies representan emergency. The diagnosis depends mainly onclinical grounds, supplemented sometimes by ra-Iological examinations (plain chest radiograph orBarium swallow occasionally.(

Varieties of vegetable and non-vegetable foreign bodies are encountered. Edentulous people withpartial dentures frequently present with ingestionof either their dentures or food- related articles like bones or meat.

Long- standing cases of aspirated foreign bodiesare frequently encountered. Family negligence orfear from bronchoscopy as well as physician un-awareness are responsible for late presentation.


The problem of foreign bodies in the oesophagus differs from that of foreign bodies further down in the GIT. The oesophagus is a rather passive and inadaptable organ and its peristalsis is not strong enough to prevent its retaining swallowed objects of many kinds. For the same reason, perforation from a foreign body is more likely to occur in the oesophagus than in the rest of the GIT.

A foreign body which has become arrested in the oesophagus should be removed as soon as the diagnosis is made for the following reasons:Once an object is impacted in the oesophagus the chance of spontaneous passage is small.

Oedema from local trauma tends to grip the object more firmly making later manipulation increasingly difficult.

Perforation of the oesophagus is much more serious and dangerous than perforation of any other part of the GIT. 19/10/22106 Prof. Abdulsalam Y Taha

This is an opportunity to inform the medicalsociety in this city that ingested and aspiratedforeign bodies can be safely managed in ourbronchoscopy unit.

Clinical awareness is the key to make a diagno-sis. Non-resolved cough in a child should raisesuspicion of foreign body inhalation.

Normal chest radiograph does not exclude thediagnosis .


Careful history may help to distinguish foreignbody aspiration from inflammatory conditionsLike croup or congenital disorders like laryngo-malacia or tracheo-malacia. However, the differ-entiation may be sometimes impossible. Then,bronchoscopy is the only way of diagnosis.

In cases of definite foreign body aspiration,bronchoscopy is curative; the child can go home the same day. If the foreign body is long-standing, a period of antibiotic therapy is needed.

Tracheostomy may be needed after removal offoreign body. Increasing strider due to laryngeal

oedema is the usual indication .19/10/22108 Prof. Abdulsalam Y Taha

Safe bronchoscopy is an art which needsplenty of time and practice to be mastered.

It requires a team of bronchoscopist andefficient anaesthesiologist aided by well-trained paramedical personnel in a unit

equipped with all necessary endoscopic andmonitoring instruments.

Although paediatric rigid bronchoscopyis explained to the family as risky procedurefor medico-legal aspects; it is a safe one

provided it is done by expert hands .19/10/22109 Prof. Abdulsalam Y Taha

FOREIGN BODIES IN AIRODIGESTIVE TRACT

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