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      Use of flexible bronchoscopy in an adult for removal of an aspirated foreign body at a community hospital

      case-report

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          Abstract

          Foreign body aspiration (FBA) is more common in children than adults with about 80% occurring in children aged less than 15 years. FBA in adults is often overlooked as a potential cause of airway obstruction especially if there is no asphyxiation. We present a case of a 45-year-old male with alcohol abuse who presented with post-obstructive pneumonia secondary to aspiration of tooth of unknown duration. The tooth was removed via flexible bronchoscopy (FBr) and we will discuss the use of FBr for foreign body (FB) removal, which FB can be easily removed by FBr, and the different techniques and devices used for FB removal via FBr.

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          Tracheobronchial foreign bodies: presentation and management in children and adults.

          F Baharloo, M Biettlot, F Veyckemans … (1999)
          To compare the clinical and management aspects of tracheobronchial aspirated foreign body (AFB) removal in children and adults; to assess the influence of the operator's experience on the outcome of the procedure. A retrospective review of a 20-year experience (from 1976 to 1996). A 900-bed university hospital. Eighty-four children up to 8 years old (the child group) and 28 adult patients (the adult group). The peak incidence of foreign body aspiration occurred during the second year of life in the child group and during the sixth decade in the adult group. The symptoms at presentation were similar in both age groups, but the diagnosis was significantly delayed in the adults. The AFBs were lodged preferentially in the right bronchial tree only in the adults; a central location was predominant (but not at all exclusive) in the children. Atelectasis was more common in the adults, and air trapping was more common in the children. The most frequent procedure was rigid bronchoscopy; when a flexible bronchoscope was used, it was always in the adult patients. When the operator was less experienced, a failed first attempt at bronchoscopy and the need for a second procedure were significantly more frequent. At presentation, the symptoms seen with AFBs do not differ according to the age of the patient; however, the delay to diagnosis, the location of the AFBs, and the radiographic images differ between child and adult populations. The removal of AFBs in patients of all ages can be performed by the same operators. Because the outcome associated with these procedures improves when the operator is experienced, the removal of AFBs should be performed in medical centers that are capable of acquiring and maintaining the necessary expertise.
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            Tracheobronchial foreign bodies in adults.

            U Prakash, Andrew Limper (1990)
            To define the clinical spectrum of tracheobronchial foreign body aspiration in adults, assess predisposing conditions, evaluate the efficacy of bronchoscopy, and determine outcome and complications. Retrospective analysis of a consecutive clinical series. A tertiary care, referral-based medical center. Sixty consecutive adult patients (over 16 years of age) evaluated for tracheobronchial foreign body aspiration. All 60 patients had bronchoscopic evaluation; 59 of them had foreign bodies identified and removal was attempted using either rigid or flexible fiberoptic bronchoscopy. Of 60 consecutive patients, 25 had underlying impairment of protective airway mechanisms (primary neurologic disorders, trauma with loss of consciousness, or sedative or alcohol use). Fifty-seven were successfully managed with bronchoscopy. Fiberoptic bronchoscopy was successful in 14 of 23 patients, and rigid bronchoscopy was successful in 43 of 44 patients, including 6 of 7 patients in whom previous fiberoptic bronchoscopy had failed. Thoracotomy was required in 3 patients. Complications of bronchoscopy were rare and not serious. Chronic complications of prolonged foreign body impaction included bronchiectasis in 3 patients. Although rare, tracheobronchial foreign body aspiration in adults can occur in various clinical settings. High clinical suspicion is necessary for diagnosis. Removal of foreign bodies can usually be accomplished with bronchoscopy.
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              Adult airway foreign body removal. What's new?

              A Rafanan, A. Mehta (2001)
              Signs and symptoms of adult FB aspiration are most often nonspecific. Misdiagnosis and delay in diagnosis frequently occur. Radiographic evaluation is helpful, but flexible bronchoscopy is the gold standard in the identification and localization of an airway foreign body. With increasing experience and development of better accessories, removal using a flexible bronchoscope under local anesthesia can be performed safely and successfully. Review of large series of FB removal indicates a success rate of 86% in more than 400 procedures with flexible bronchoscopy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Community Hosp Intern Med Perspect
                Journal ID (iso-abbrev): J Community Hosp Intern Med Perspect
                Journal ID (publisher-id): JCHIMP
                Title: Journal of Community Hospital Internal Medicine Perspectives
                Publisher: Co-Action Publishing
                ISSN (Electronic): 2000-9666
                Publication date (Electronic): 19 October 2015
                Publication date Collection: 2015
                Volume: 5
                Issue: 5
                Electronic Location Identifier: 10.3402/jchimp.v5.28589
                Affiliations
                Department of Pulmonary Medicine, Interfaith Medical Center, Brooklyn, NY, USA
                Author notes
                [* ]Correspondence to: Vikram Oke, Department of Pulmonary Medicine, Interfaith Medical Center, 1545 Atlantic Ave., Brooklyn, NY 11213, USA, Email: Vikramoke@ 123456gmail.com
                Article
                Publisher ID: 28589
                DOI: 10.3402/jchimp.v5.28589
                PMC ID: 4612481
                PubMed ID: 26486107
                SO-VID: a1bfc021-4c6f-4f37-8453-2434c82e5894
                Copyright © © 2015 Vikram Oke et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 May 2015
                Date revision received : 28 June 2015
                Date accepted : 09 July 2015
                Categories
                Subject: Case Report

                Keywords: foreign body aspiration in adults,flexible bronchoscopy,post-obstructive pneumonia
                Data availability:
                Keywords: foreign body aspiration in adults, flexible bronchoscopy, post-obstructive pneumonia

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