BRONCHOSCOPIC MANAGEMENT OF TRACHEOBRONCHIAL FOREIGN BODIES INHALATION AND ITS SEQUELAE ON THE RESPIRATORY SYSTEM

Abstract

Tracheobronchial foreign body inhalation is a dramatic event and is one of the main causes of morbidity and mortality (118);yet is commonly missed by physicians. Early diagnosis and removal of foreign bodies must be achieved to avoid complications. Diagnosis of foreign body in the airways is still a challenge for the physicians. Only bronchoscopy gives certainty about the diagnosis(123). The present study aimed to evaluate the effect of foreign bodies inhalation on the respiratory system and its sequelae as regards complications during and after bronchoscopy and lung recovery. The present study is a prospective interventionaland follow-up, the patients were recruited from bronchology unit – pulmonary department Ain Shams University Hospitals, who were referred with clinical and/or radiological suspicion of FBI in the period of June 2013 and May, 2015. It was conducted on 75 patients 38 females (50.67%) and 37 males (49.33%) whose ages ranged from 5 months to 60 years. It was found that patients younger than 3 years old were 40 (53.33%) and who were older than 3 years 35 (46.66%) with insignificant statically difference. Most of the patient (82%) were associated with confirmed witness of inhalation.

The commonest risk factors associated with FB inhalation were: talking/playing while eating followed by holding objects in mouth while talking or laughing. The range of duration before presentation were from few hours to more than 9 month. It was considered that three weeks was found to be the duration required for the patient to be categorized as early or late case. The commonest clinical manifestations among early cases (who presented within 3 weeks) were: choking with high significant statistically difference (P <0.001) while recurrent chest infection was the commonest among the late cases (who presented after 3 weeks) with high significant statistical difference (p<0.001).Respiratory distress, fever, anorexia, loss of weight and unilateral/localized hyperinflation also were the commonest among late case with significant statistical difference p value (0.005, 0.002, 0.005, 0.028 respectively). The commonest radiological findings were: obstructive emphysema followed by collapse then consolidation and bronchiectasis; most of these findings were on the right side. It was illustrated that radiological evidences of FBs were either radiopaque shadow in 33.3% of patients or filling defect within airway in 21.3% while no evidence of FBs in 45.33% of patients. The bronchoscopic procedure was done for 75 patient where FBs were found in 89.33% of the patients. It was illustrated that the commonest radiological and bronchoscopical sites were: RT. main bronchus followed by Lt. main bronchus. The commonest types of inhaled FBs were organic in 56% of the cases in the form of seeds and nuts while inorganic FBs found in 33.33% of the cases where scarf pin were the commonest type. It was noted that 71.43% of organic FBs inhalation were presented late (after 3weeks) while 68% of inorganic FBs were presented early (within 3 weeks) with significant statistical difference (p=0.004). The commonest complications in the tracheobronchial tree resulting from FBI were: bleeding followed by granulation tissue then purulent secretion and airway stenosis. It was noticed that these complications were more among late cases than early cases with high significant statistical difference (p <0.001) especially with granulation tissue that recorded more in patients younger than 3 years old with high significant statistical difference (p<0.001). It also noted that these complicated IFB were associated with longer procedure time (>30 min) especially if associated with granulation tissue, bleeding and purulence with high significant statistical difference (p<0.001), while with significant statistical difference if associated with airway stenosis (P=0.003).