Foreign bodies in the tracheobronchial tree.

Between 1972 and 1984, we treated 66 patients with foreign bodies (FBs) in the tracheobronhial tree. Twenty-six patients (39.4 percent) were between one and two years old; 52 (78.8 percent) were under age ten. Forty-four FBs (67 percent) were fruit and vegetable seeds and nuts. Soft organic material (meat, cucumber peels) was found in four patients, chicken bones in six, pins and needles in six, other nonorganic materials (toys, stone, broken thermometer) in six. In 55 patients, the FB was removed at bronchoscopy; three patients coughed up the FB shortly after bronchoscopy. Eight patients were operated on because the impacted FB could not be removed at repeat bronchoscopy trials. In this group, the FB was removed through a bronchotomy in two patients, but in six, pulmonary resection was necessary because of severe bronchiectasis (FBs had been impacted from ten months to 12 years). Stiff bronchoscope was used in all patients. In several cases, the flexible bronchoscope was used initially but proved inadequate. There were three complications, two related to hypoxia, but no deaths. Infants and little children should be prevented from reaching peanuts and seeds. When presence of a FB is suspected, and in children with unresolving pneumonic process, early bronchoscopy is mandatory. Expert anesthesia is essential, and hypoxia must be avoided.