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      Endoscopic procedures for removal of foreign bodies of the aerodigestive tract: The Bugando Medical Centre experience

      research-article
      1 , , 1
      BMC Ear, Nose, and Throat Disorders
      BioMed Central

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          Abstract

          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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          Most cited references18

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          Foreign body in the oesophagus: review of 2394 cases.

          A total of 2394 patients with a foreign body in the oesophagus was treated in our unit between 1965 and 1976, including 343 children in whom fish bones (146) and coins (134) were most commonly responsible; in adults, bones (fish and chicken) were commonest. Most of the foreign bodies were impacted in the cervical oesophagus. Pharyngoscopy and oesophagoscopy were carried out under general anaesthesia in all cases except those in which the foreign body was ejected spontaneously or when the patient refused the examination. Oesophageal perforation due to a foreign body was encountered in only one child. Two patients in the series developed the fearsome complication of oesophagoaortic fistula.
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            Complications of foreign bodies in the esophagus.

            Major complications of foreign bodies in the esophagus carry significant morbidity and mortality risks. A retrospective case control study was performed to assess the factors associated with major complications. In total, 273 patients seen within a 7-year period were divided into 2 groups; 253 had no or minor complications, and 20 had major complications. Age, sex, duration of the foreign body, total white cell count (TWC), and nature and site of the foreign body were analyzed in the 2 groups. The major complication rate was 7.3%. Duration of the foreign body and TWC were the only statistically significant factors associated with major complications. Six patients required open neck exploration, 1 had an open thoracotomy, and 13 were treated by endoscopic removal. There were 2 deaths. Given the significant morbidity and mortality risks, we conclude that patients with a prolonged history of a foreign body in the esophagus and a raised TWC should be treated urgently.
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              Foreign bodies in the aerodigestive tract in pediatric patients.

              To investigate pediatric foreign body cases in the aerodigestive tract, and to elucidate the characteristic problems in Japan. A total of 310 pediatric patients (age 15 or below), gathered from two medical university hospitals (University of Tokyo and Jichi Medical School), were included in this study. Data were collected by retrospective chart review and were statistically analyzed. Two-year-olds were the most common patients, and the range from age 1 to age 4 included 67.7% of all the patients. The most involved sites were the nose (39.4%) and the pharynx (38.4%), followed by the esophagus (12.9%) and the trachea-bronchi (6.5%). Fish bones and toys were the representative foreign bodies (30.7 and 13.6%, respectively). Other foreign bodies often encountered included coins, food, candy, peanuts and nuts, and batteries. The type of foreign body was closely related to the site in which foreign bodies were lodged: 77.3% of foreign bodies in the pharynx were fish bones, and toys were the most common impacted foreign body in the nose. In the esophagus, representative impacted foreign bodies were coins (35.7%), but disk-type battery ingestion has been increasing in recent years. Although most foreign bodies in the esophagus were safely removed, one case of a disk-type battery had a serious sequela. In the trachea-bronchi, peanuts, food, cotton, and coins were impacted. A rigid bronchoscope was basically used to remove foreign bodies, but in some cases, a fine flexible endoscope, with a channel for fiber forceps, was useful, because it could be inserted into narrow bronchi. Advance of a flexible endoscope will make it an excellent tool for diagnosis and management of the trachea-bronchial foreign body. Fish bones in the pharynx, which were closely related to Japanese eating habits, and toys in the nose, were the typical foreign bodies encountered in this study. In the esophagus, an increased incidence of disk-type battery ingestion has become a serious problem in recent years. Since prevention is the most essential way to manage foreign body cases, feedback from studies to public education should be encouraged.
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                Author and article information

                Journal
                BMC Ear Nose Throat Disord
                BMC Ear, Nose, and Throat Disorders
                BioMed Central
                1472-6815
                2011
                21 January 2011
                : 11
                : 2
                Affiliations
                [1 ]Department of Surgery, Weill- Bugando University College of Health Sciences, Mwanza, Tanzania
                Article
                1472-6815-11-2
                10.1186/1472-6815-11-2
                3033844
                21255409
                e0943b45-2050-4df7-aec7-929679434e5f
                Copyright ©2011 Gilyoma and Chalya; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 October 2010
                : 21 January 2011
                Categories
                Research Article

                Otolaryngology
                Otolaryngology

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