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ISSN: 2161-105X
Journal of Pulmonary & Respiratory Medicine
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Tracheobronchial Metallic Foreign Body Spontaneous Inhalation in a Child during Magic Game

Togo S1*, Ouattara MA1, Coulibaly I1, Sadibou C1, Koumaré S2, Yang SW3 and Yena S1

1Department of Thoracic surgery, Mali Hospital, Mali

2Department of Surgery, Point G Hospital, Mali

3Department of Endoscopy, Mali Hospital, Mali

*Corresponding Author:
Seydou Togo
Department of Thoracic surgery
Mali Hospital, Bamako, Mali
Tel: +223 65511651
E-mail: [email protected] yahoo.fr

Received date: October 16, 2015; Accepted date: December 16, 2015; Published date: December 21, 2015

Citation: Togo S, Ouattara MA, Coulibaly I, Sadibou C, Koumaré S, et al. (2015) Tracheobronchial Metallic Foreign Body Spontaneous Inhalation in a Child during Magic Game. J Pulm Respir Med 5:301. doi:10.4172/2161-105X.1000301

Copyright: © 2015 Togo S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood and still one of the most common pediatric emergencies. We report the case of a 4 year-old male child who aspirated a shaped metallic foreign body placed in his mouth while playing magic in school, highlighting prevention via parental education and avoidance of objects that produce the greatest risk with children. The clinical presentation was cough, sputum and chest pain which was relieved almost instantly after aspiration. Early diagnosis and treatment with rigid bronchoscopy under general anesthesia should be performed by experienced personnel in patients suspected of foreign body aspiration to avoid life threatening respiratory sequelae. There is a need of exercise caution by parents in the handling of their children.

Keywords

Aspiration; Foreign body; Children

Background

Tracheobronchial metallic foreign bodies are very serious injuries. It occurs more commonly in children under the age of five, owing to their insufficient airway protection reflex, poor chewing ability, and harmful habits of exploring objects with mouth as well as eating while crying or playing. The current mortality rate from foreign body aspiration according to a reported study is between 0 to 1.8% [1]. The management of aspirated foreign bodies is still by radiological means and the use of bronchoscopes either rigid or flexible fibreoptic. Tracheobronchial metallic foreign bodies early detection and removal is necessary to avoid life threatening respiratory sequelae such as atelectasis, pneumonia, pulmonary hyperinflation and pneumomediastinum [2]. Reduction of these injuries by prevention can be achieved via parental education and avoidance of objects that produce the greatest risk [3]. We present an unusual aspiration of metallic foreign body placed in his mouth while playing magic by a child with a tracheobronchial shaped radio-opaque foreign body, highlighting prevention with the exercise of caution by parents in the handling of their children.

Case Presentation

A 4-year-old male child was referred from the rural medical center, on account of an aspirated foreign body he had placed in his mouth while playing magic in school. Immediately the patient had bouts of coughing followed by right-sided and retrosternal chest pain which was relieved almost instantly. Teachers and classmate of the boy were reassured by the father at school making them believe after playing another magic gesture that the foreign body was removed. His father for financial needs was used to play magic making the boy follow him to learn magic gestures by using a spikes, nail, pens trying to hold them between teeth, making them disappeared and highlighted from the mouth. He presented to us 2 days following aspiration. He was found to be calm and not dyspnoeic at admission. The parents denied any history of allergy, atopy, hemoptysis, abdominal pain or loss of appetite. His vitals were: blood pressure: 100/70 mm of Hg, pulse rate of 124/ min, respiratory rate of 25/ min, and oxygen saturation on breathing room air 97%. Chest examination revealed decreased air entry in the right hemithorax. Chest x-ray (anterior-posterior and lateral views) taken in our hospital confirmed the presence of a shaped radio-opaque object in the right tracheobronchial tree (Figure 1). He was prepared for a bronchoscopy and had rigid bronchoscopy with the removal of a metallic shaped foreign body (Figure 2) at our hospital. The patient did well post-operatively with antibiotic therapy. He was discharged on the second post-operative day. The 3 month follow-up was uneventful.

clinical-experimental-ophthalmology-anterior-posterior

Figure 1: Chest x-ray showing the radio-opaque foreign body in the tracheobronchial tree. A. anterior-posterior view. B. Lateral view

clinical-experimental-ophthalmology-foreign-body

Figure 2: The extracted metallic foreign body.

Discussion

Foreign body aspirations constitute a reasonable percentage of respiratory emergencies in the pediatric age group, causing morbidity and mortality [4]. Additionally, children are highly interested in and tend to explore environmental objects with mouth [5].These factors contribute to a high incidence of TFB in young children. Tracheobronchial metallic foreign bodies occur less frequently as compared to organic foreign bodies [6]. The clinical presentation is cough, sputum, dyspnea, wheezing, chest pain and fever [2,4]. They may lead to serious complications such as airway inflammation, hemoptysis, bronchiectasis, pulmonary atelectasis, and even asphyxia and death [7]. The best treatment is rigid bronchoscopy in order to prevent life threatening respiratory complications [8]. Endobronchial foreign bodies can be very difficult to remove depending on the type and location of the foreign body, the experience of the bronchoscopist and the availability of the appropriate instruments for removal [9]. The most frequently aspirated objects were shelled nuts and seeds such as sunflower seeds, pistachio and hazelnuts [10]. Shaped metallic objects are relatively uncommon. The presenting symptoms are cough, sputum, dyspnea, wheezing and fever [6], but this also depends on the type of foreign body aspirated as evidenced by the calm presentation of our patient despite showing up in hospital two days following aspiration of the foreign body. The foreign body aspirated by our patient was a shaped metallic object (a spike) which was lying vertically in the right main bronchus and still allowed air into the lungs without complete obstruction. Our patient had plain x-rays which revealed the metallic foreign body, further highlighting the importance of plain radiographs in diagnosing aspirated metallic foreign bodies. In recent times, the management of pediatric foreign bodies has become refined both from a diagnostic and therapeutic standpoint [11]. New techniques like helical computerized tomographic (CT) virtual bronchoscopy are being used in the evaluation of children with suspected aspiration of foreign bodies [12]. Early diagnosis and treatment of tracheobronchial foreign bodies is of utmost importance to avoid life threatening respiratory sequelae which include pneumonia, atelectasis, pulmonary hyperinflation and pneumomediastinum [2]. This therefore is a call to parents to a good behavior and for exercise caution in the handling of children to avoid unnecessary risks which could endanger their lives. Parents should ensure that dangerous objects are kept away from their children in order to prevent such injuries.

Conclusion

Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. Early diagnosis and prompt treatment of aspirated foreign body with rigid bronchoscopy under general anesthesia are of significance in reducing complications and mortality in affected children. Prevention can be achieved via parental education and avoidance of objects that produce the greatest risk.

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