Bronchial Foreign bodies Retrieval using Flexible Fibreoptic Bronchoscope
Keywords:Bronchoscopy, Bronchial, Fibreoptic bronchoscopy, Foreign body, Removal
AbstractIntroduction: Flexible fibreoptic bronchoscopy can be utilized as a useful diagnostic and therapeutic tool to evaluate and extract airway foreign bodies in a variety of situations both in adults and children. Symptoms of foreign body (FB) aspiration are variable depending upon size, type and location of FB in the respiratory tract.Objectives: Cross sectional study with retrospective analysis of patterns and types of bronchial FBs as well as outcome and safety of their bronchoscopic retrieval during the last 2 years (2015-2017), conducted at the department of pulmonology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute (FPGMI) Lahore, Pakistan.Patients & Methods: Twelve patients required bronchial foreign bodies' removal, including 7 males (58%) and 5 females (42%), having ages between 8-80 years (mean age 26.33 years). Procedures were done under topical anesthesia using lignocaine 2% and intravenous midazolam & fentanyl for procedural sedation and analgesia. Symptoms and FB related airway complications were dependent on the duration of FB remaining in the airway; scarf pins aspiration of one day duration was associated with intense anxiety, bronchitis or pneumonia if FB remained in the airway for days to weeks and non resolving pneumonia and lung abscesses if duration of airway FB was in weeks to months.Results: The 12 FBs which were successfully (100%) removed consisted of plastic material (4 cm in length and 1.8 cm in width), walnut shell (1.4 cm), metallic LED toy light bulb (2.5 cm), four headscarf pins (3.5 cm each), one clothe packing pin (2.5 cm), a thumb pin (2.2 cm), two teeth and a sewing machine needle (3.8 cm). Pins aspiration (scarf pins, sewing machine needle) were more common among females while organic FBs (tooth, plastic material, walnut shell) aspiration was frequently observed among males. The minimal time for removal (bronchoscopy procedure) was for a clothe packing pin (10 minutes) in a 17 year-old-male and maximum time for FB removal was in a 34 year-old–male with walnut shell aspiration requiring 2 bronchoscopic sessions of 3 hours total duration. No major complication (0%) occurred during the interventions and all procedures were successful with none requiring referral for rigid bronchoscopy or bronchotomy.Conclusion: Flexible fibreoptic bronchoscopy is practically useful and safe for the diagnosis and retrieval of endobronchial foreign bodies.