CRCM  Vol.2 No.5 , August 2013
The use of fiberoptic bronchoscope to remove aspirated tracheobronchial foreign bodies: Our experience
Author(s) Abdulsalam Y. Taha*
ABSTRACT
Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in children who form the major affected population. Fiberoptic bronchoscopy (FOB) has also been used for FB removal in many countries, though in Iraq, the standard mean remains rigid bronchoscopy. Objective: Herein, we present 5 cases of FB inhalation in adults in whom FOB was used for removal. The aim is to test its feasibility with literature review. Setting: the department of thoracic surgery/Sulaimania Teaching Hospital/Sulaimania/Iraq. Study Design: a prospective study of 5 patients. Patients and methods: 5 patients (3 females and 2 males) with different bronchial or laryngeal FBs in whom FOB was used as a method for removal are presented. The age ranged from 16 to 71 years. The clinical and radiographic features are recorded. In all these patients, initial FOB examination under local anesthesia transorally or via tracheotomy stoma was done. When removed by this method failed, RB under GA was used and when this failed, thoracotomy was the last resort. Results and Conclusions: FBs encountered in this paper consisted of pins (n = 2), sewing needle (n = 1), speech valve (n = 1) and a medical leach (n = 1). Three FBs (medical leach, speech valve and one pin) were successfully removed by FOB. A pin in RMB was visualized but failed to be removed by FOB and therefore, RB was required for its retrieval, while a needle in left lower lobe was invisible by both FOB and RB and thus surgery was necessary to remove it. We conclude that in adolescent or adult patients with bronchial FBs, FOB should be tried first for removal. If this fails then RB can be used. To increase its success, FOB should be combined with certain accessories like special FB forceps and fluoroscopy.

Cite this paper
Taha, A. (2013) The use of fiberoptic bronchoscope to remove aspirated tracheobronchial foreign bodies: Our experience. Case Reports in Clinical Medicine, 2, 285-290. doi: 10.4236/crcm.2013.25077.
References
[1]   Chin-Wing, Y.U. (2012) Rigid bronchoscopy—A physiccian’s perspective. Hong Kong Respiratory Medicine. The official website of HKTS, ACCP HK & Macau, HKLF.

[2]   Elhassani, N.B. (1978) Aspirated tracheobronchial foreign bodies in infants. Annals of the Royal College of Surgeons of England, 23, 310-314.

[3]   Hussein. W.M. (1984) Tracheobronchial foreign bodies in pediatric age group. Journal of the Faculty of Medicine, Baghdad, 26, 63-72.

[4]   Abdulameer, M.H. (2010) Foreign bodies inhalation. Journal of the Faculty of Medicine, Baghdad, 52, 255-258.

[5]   Swanson, K.L. and Edell, E.S. (2001) Tracheobronchial foreign bodies. Chest Surgery Clinics of North America, 11, 861-872.

[6]   Lan, R.S., Lee, Ch., Chiang, Y.C. and Wang, W.J. (1989) Use of fiberoptic bronchoscopy to retrieve bronchial foreign bodies in adults. American Review of Respiratory Disease, 140, 1734-1737. doi:10.1164/ajrccm/140.6.1734

[7]   Donado Una, J.R., de Miguel Poch, E., Casado Lopez, M.E. and Alfaro Abreu, J.J. (1998) Fiberoptic bronchoscopy in extraction of tracheobronchial foreign bodies in adults. Arch Bronchopneumol, 34, 76-81.

[8]   Muhammad, T.D., Saad, M.M., Bahaa, M.A. and Omer, R.H. (2010) Tracheo-bronchial foreign bodies inhalation in Al-Anbar Governorate. Kufa Medical Journal, 13, 248-262.

[9]   Akhtar, S. and Ul Hak, I. (2006) An experience with leeches in the aero-digestive tract. http://www.pafmj.org/showdetails.php?id=60&t=c

[10]   Boyd, M., Chatterjee, A., Chiles, C. and Chin Jr., R. (2009) Tracheobronchial foreign body aspiration in adults. Southern Medical Journal, 102, 171-174. doi:10.1097/SMJ.0b013e318193c9c8

[11]   Ramirez-Figueroa, J.L., Gochicoa-Rangel, L.G, RamirezSan Juan, D.H. and Vargas, M.H. (2005) Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatric Pulmonology, 40, 392-397. doi:10.1002/ppul.20242

[12]   Mise, K., Jurcev Savicevic, A., Pavlov, N. and Jankovic, N. (2009) Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: Experience 1995-2006. Surgical Endoscopy, 23, 1360-1364. doi:10.1007/s00464-008-0181-9

[13]   Gencer, M., Ceylan, E. and koksal, N. (2007) Extraction of pins from the airway with flexible bronchoscopy. Respiration, 74, 674-679.

[14]   Hasdiraz, L., Bicer, C., Bilgin, M. and Oguzkaya, F. (2006) Turban pin aspiration: Non-asphyxiating tracheobronchial foreign body in young Islamic women. Thoracic and Cardiovascular Surgeon, 54, 273-275. doi:10.1055/s-2006-923954

[15]   Kaptanoglu, M., Dogan, K., Onen, A. and Kunt, N. (1999) Turban pin aspiration; a potential risk for young Islamic girls. International Journal of Pediatric Otorhinolaryngology, 48, 131-135.

[16]   El-Kushman, H.M., Sharara, A.M., Sa Ada, M.A. and Hijazi, Ma. (2007) Tracheobronchial straight metallic pin aspiration in young Jordanian females. Saudi Medical Journal, 28, 913-916.

[17]   Al-Ali, M.A., Khassawneh, B. and Alzoubi, F. (2007) Utility of fiberoptic bronchoscopy for retrieval of aspirated headscarf pins. Respiration, 74, 309-313. doi:10.1159/000098477

[18]   Murthy, P.S., Ingle, V.S., George, E., Ramakrishna, S. and Shah, F.A. (2001) Sharp foreign bodies in the tracheobronchial tree. American Journal of Otolaryngology, 22, 154-156. doi:10.1053/ajot.2001.22585

[19]   Nguyen, L.H., Huy, D., Nogoc, T., Nguyen, P.T., Thi, Q.H., Aelony, Y. and Homasson, J.P.D. (2010) Endobronchial foreign bodies in Vietnamese adults are related to eating habits. Respirology, 15, 491-494.

[20]   Ten Hallers, E.J., Marres, H.A., Rakhorst, G., Hagen, R., Staffieri, A., Van Der Laan, B.F., Van Der Houwen, E.B. and Verkerke, G.J. (2005) Difficulties in the fixation of prostheses for voice rehabilitation after laryngectomy. Acta Oto-Laryngologica, 125, 804-813. doi:10.1080/00016480510031506

 
 
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