Bose Sumona, Shubha Attibele Mahadevaiah
Department of Paediatric Surgery, All India Institute of Medical Sciences, Kalyani, West Bengal, India.
Department of Pediatric Surgery, St. Johns Medical College and Hospital, Bengaluru, Karnataka, India.
J Indian Assoc Pediatr Surg. 2024 Sep-Oct;29(5):536-540. doi: 10.4103/jiaps.jiaps_76_24. Epub 2024 Aug 23.
The aim is to study the demographics and management of unusual airway foreign bodies (UAFBs) in children.
A retrospective observational study (2000-2020) of children with UAFBs, who underwent bronchoscopic removal. The demographics, types of foreign bodies, clinical and radiological features, management, and outcomes were collated and analyzed. Common foreign bodies, such as nuts, seeds, and vegetable aspirations, were excluded.
Among 531 children who had bronchoscopic retrieval of airway foreign bodies, 74 (59 males/15 females) had unusual foreign bodies. These included pen caps, whistles, plastic objects, pins, coal piece, stones, clay, pencil, gold ornament, and glass bangle. Thirty-one children presented within 1 day of aspiration, 37 within 1 month and 6 till 6 months. Thirty-nine were below 5 years, and the rest were between 5 and 15 years. Cough, respiratory distress, fever, choking, and noisy breathing were common presentations. Others are stridor, whistling, cyanosis, loss, and change of voice. Chest X-ray showed ipsilateral hyperinflation (23), haziness (21), radio-opaque foreign body (17) and was normal in 14. The left main bronchus, followed by the right main bronchus and trachea, were the sites of impaction. Four children required additional procedures (tracheotomy and thoracotomy). There was one mortality in the study cohort.
Aspiration of unusual foreign bodies is not uncommon in children. Most aspirations are witnessed and predominant in boys. The left bronchus is the common site of impaction, and X-ray clinches the diagnosis. Presentation is delayed, and bronchoscopic retrieval, though challenging, has favorable outcome.
旨在研究儿童特殊气道异物（UAFB）的人口统计学特征及处理方法。
对2000年至2020年期间接受支气管镜下异物取出术的UAFB患儿进行回顾性观察研究。整理并分析其人口统计学特征、异物类型、临床及放射学特征、处理方法及结果。排除坚果、种子和吸入性蔬菜等常见异物。
在531例接受支气管镜气道异物取出术的儿童中，74例（男59例/女15例）有特殊异物。这些异物包括笔帽、口哨、塑料制品、别针、煤块、石头、黏土、铅笔、金饰和玻璃手镯。31例患儿在误吸后1天内就诊，37例在1个月内就诊，6例在6个月内就诊。39例年龄在5岁以下，其余在5至15岁之间。咳嗽、呼吸窘迫、发热、窒息和呼吸嘈杂是常见症状。其他症状有喘鸣、哨音、发绀、声音丧失和改变。胸部X线显示同侧肺过度充气（23例）、模糊（21例）、不透射线异物（17例），14例正常。异物嵌顿部位依次为左主支气管、右主支气管和气管。4例患儿需要额外的手术（气管切开术和开胸手术）。研究队列中有1例死亡。
儿童误吸特殊异物并不少见。大多数误吸情况有目击，且以男孩为主。左支气管是常见的嵌顿部位，X线有助于确诊。就诊延迟，支气管镜下取出异物虽具挑战性，但预后良好。
