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      Foreign bodies in the aerodigestive tract: time for comprehensive preventive measures

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          Abstract

          Background

          Foreign body (FB) in the aerodigestive tract presents more commonly in children and remains a surgical emergency with potential for fatal complications.

          Objectives

          To describe management and outcomes of aerodigestive FB managed at University of Ilorin Teaching Hospital (UITH) and proffer preventive measures.

          Methods

          A 9-year retrospective review of all patients with foreign body in the aerodigestive tract managed between March 2011 and July 2020.

          Results

          Sixty-six patients were studied. Median age was 9years with M:F ratio =1.6:1. FB was ingested in 38(57.6%) patients, aspiration occurred in 28(42.4%). Denture was most common FB 20(30.3%); plastic whistle/valve placed in dolls or football accounted for 4(6.1%). When ingested, FB was impacted in cervical 17(44.7%), upper thoracic 10(26.3%) and middle thoracic 2(5.3%) oesophagus. Oesophagoscopy was used in 30(8.9%) for retrieval. When aspirated, FB was located in the right bronchus 10(35.7%), left bronchus 7(25.0%), hypopharynx and trachea 2(7.1%) each, and cricopharynx 1(3.5%); no FB was found in 3(10.7%) patients. Direct Laryngoscopy was the method of retrieval in 3(10.1%) patients while others had rigid bronchoscopy. Mortality rate was 1.5%.

          Conclusion

          Children are most vulnerable group. Preventive effort should include public health education and close monitoring of children by parents and care givers during play.

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          Most cited references22

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          Foreign bodies in the airways: a meta-analysis of published papers.

          Francesca Foltran, Simonetta Ballali, Francesco Maria Passali … (2012)
          Very recently, some attempts have been made to start a systematic collection of foreign bodies (FB) in view of using them to characterize the risk of chocking in terms of size, shape and consistency of the FB. However, most of the epidemiologic evidence on foreign bodies in children comes from single-center retrospective studies, without any systematic geographical and temporal coverage. This paper is aimed at providing an estimate of the distribution of foreign body's injuries in children according to gender, age, type of FB, site of obstruction, clinical presentation, diagnostic/therapeutic procedures, complications, as emerging from a meta-analytic review of published papers.
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            Foreign body aspiration: clinical utility of flexible bronchoscopy.

            C Usalan, O Dikensoy, A Filiz (2002)
            Foreign body aspiration is a worldwide health problem which often results in life threatening complications. More than two thirds of foreign body aspirations occur among children younger than 3 years. Organic materials such as nuts, seeds, and bones are most commonly aspirated. There is a wide range of clinical presentation, and often there is not a reliable witness to supply the clinical history, especially in children. Maintaining a high index of suspicion is therefore necessary for the diagnosis. None of the imaging methods employed in such cases are diagnostic, and bronchoscopy is frequently necessary for the diagnosis as well as the treatment. In adults, removal of the foreign body can be attempted during diagnostic examination with a fibreoptic bronchoscope under local anaesthesia, which may help to avoid any further invasive procedures with more complications. When diagnosis is delayed, complications of a retained foreign body such as unresolving pneumonia, lung abscess, recurrent haemoptysis, and bronchiectasis may necessitate a surgical resection. However, some of the late complications may resolve completely after the retrieval of the foreign body, therefore, a preoperative flexible bronchoscopy should always be considered in suitable cases.
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              Endoscopic procedures for removal of foreign bodies of the aerodigestive tract: The Bugando Medical Centre experience

              Japhet M Gilyoma, Phillipo Chalya (2011)
              Background Foreign bodies in the aerodigestive tract continue to be a common problem that contributes significantly to high morbidity and mortality worldwide. This study was conducted to describe our own experience with endoscopic procedures for removal of foreign bodies in the aerodigestive tract, in our local setting and compare with what is described in literature. Methods This was a prospective descriptive study which was conducted at Bugando Medical Centre between January 2008 and December 2009. Data were collected using a structured questionnaire and analyzed using SPSS computer software version 15. Results A total of 98 patients were studied. Males outnumbered females by a ratio of 1.1:1. Patients aged 2 years and below were the majority (75.9%). The commonest type of foreign bodies in airways was groundnuts (72.7%) and in esophagus was coins (72.7%). The trachea (52.2%) was the most common site of foreign body's lodgment in the airways, whereas cricopharyngeal sphincter (68.5%) was the commonest site in the esophagus. Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality performed in 87.8% of patients. The foreign bodies were successfully removed without complications in 90.8% of cases. Complication rate was 7.1% and bronchopneumonia was the most common complication accounting for 42.8% of cases. The mean duration of hospital stay was 3.4 days and mortality rate was 4.1%. Conclusion Aerodigestive tract foreign bodies continue to be a significant cause of childhood morbidity and mortality in our setting. Rigid endoscopic procedures under general anesthesia are the main treatment modalities performed. Prevention is highly recommended whereby parents should be educated to keep a close eye on their children and keep objects which can be foreign bodies away from children's reach.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Afr Health Sci
                Journal ID (iso-abbrev): Afr Health Sci
                Title: African Health Sciences
                Publisher: Makerere Medical School (Kampala, Uganda )
                ISSN (Print): 1680-6905
                ISSN (Electronic): 1729-0503
                Publication date (Print): June 2022
                Volume: 22
                Issue: 2
                Pages: 369-376
                Affiliations
                [1 ] Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Ilorin
                [2 ] Department of Otorhinolaryngology, University of Ilorin
                [3 ] Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Ilorin Teaching Hospital
                [4 ] Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital
                [5 ] Department of Anaesthesia, University of Ilorin
                [6 ] Department of Otorhinolaryngology, University of Ilorin Teaching Hospital
                [7 ] Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital
                [8 ] Department of Anaesthesia, University of Ilorin Teaching Hospital
                Author notes
                Corresponding author: Peter OladapoAdeoye, Division of Thoracic & Cardiovascular Surgery Department of Surgery, University of Ilorin, University of Ilorin Teaching Hospital P.M.B. 1459, Ilorin. G.P.O. Box 778, Ilorin. Nigeria. adeoye.po@ 123456unilorin.edu.ng , poadeoye@ 123456yahoo.ca
                Article
                Publisher ID: jAFHS.v22.i2.pg369
                DOI: 10.4314/ahs.v22i2.42
                PMC ID: 9652635
                PubMed ID: 36407405
                SO-VID: 8dc8e352-e45c-4d14-84c2-b8a13f001ec8
                Copyright © © 2022 Adeoye PO et al.
                License:

                Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License ( https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Articles

                Keywords: foreign body,aspiration,ingestion,aerodigestive tract,impaction
                Data availability:
                Keywords: foreign body, aspiration, ingestion, aerodigestive tract, impaction

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