Id El Haj Najat, Adnane Maha, Ziati Jihane, El Kettani Chafik, Haoudar Amal
Thoracic Surgery, Université Hassan II, Casablanca, MAR.
Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Casablanca, MAR.
Cureus. 2024 Sep 23;16(9):e70023. doi: 10.7759/cureus.70023. eCollection 2024 Sep.
Foreign body (FB) inhalation in children is a common and potentially life-threatening occurrence encountered in pediatric emergency medicine. A wide range of clinical presentations including often delayed onset of symptoms make it challenging to identify and provide a timely diagnosis. This increases the risk of complications and leads to suboptimal outcomes. For instance, inhalation of sharp objects may lead to perforations and migrations to surrounding structures making it difficult to retrieve the FB as seen in this case. Additionally, the onset of symptoms can vary, making it difficult to diagnose based on a patient's history alone. An unusual case of an inhaled sharp metallic object (dental bur) in a 13-year-old boy that migrated from the left lower thorax to the right perihilar and finally to the gastric lumen is presented a week after the incident. A 13-year-old boy presented to the emergency department with mild symptoms. He was stable with normal chest findings. Previous rigid bronchoscopy failed to localize and remove the FB and the thoracotomy. A post-operative X-ray was done, and the migration of the FB to the right middle lobe was revealed. A flexible bronchoscopy was then performed, again with no positive results. It was finally the abdominopelvic CT scan followed by the gastroduodenal esophagoscopy that allowed us to visualize and remove the FB from the gastric lumen. In this case, we review the literature to emphasize the diagnostic challenges of FB inhalation in children, focusing on key diagnostic clues that assist clinicians in managing this condition.
儿童异物吸入是儿科急诊医学中常见且可能危及生命的情况。包括症状通常延迟出现在内的广泛临床表现使得识别和及时诊断具有挑战性。这增加了并发症的风险并导致不理想的结果。例如，吸入尖锐物体可能导致穿孔并迁移至周围结构，使得如本病例所见难以取出异物。此外，症状的发作可能各不相同，仅根据患者病史难以诊断。本文介绍了一名13岁男孩吸入尖锐金属物体（牙钻）的罕见病例，该物体在事件发生一周后从左下胸部迁移至右肺门周围，最终进入胃腔。一名13岁男孩因症状轻微就诊于急诊科。他情况稳定，胸部检查结果正常。先前的硬质支气管镜检查未能定位和取出异物以及进行开胸手术。术后进行了X线检查，发现异物迁移至右中叶。随后进行了柔性支气管镜检查，同样未取得阳性结果。最终是腹部盆腔CT扫描，随后进行胃十二指肠食管镜检查，才使我们能够看到并从胃腔中取出异物。在本病例中，我们回顾文献以强调儿童异物吸入的诊断挑战，重点关注有助于临床医生处理这种情况的关键诊断线索。
