Doctors give new life to kid by removing complex foreign body from wind pipe: Challenging management

On examination she had tachypnea, with SPO2 -80% at room air

Pragativahini News, Belagavi – A 11-year-old female child with cough, fever and respiratory distress increasing since 4-5 days was referred to KLES Dr. Prabhakar Kore hospital & MRC Belagavi. Patient gave no history of foreign body.

On examination she had tachypnea, with SPO2 -80% at room air. Further investigation were done by pediatrics team (Dr Tanmaya Metgud, Dr Sujata Jali and Dr Zeeshan Desai), Bilateral pneumothorax with massive surgical emphysema and Tracheal injury was suspected on HRCT. On reviewing HRCT and suspecting Foreign body by Pediatric team & Pediatric Surgeon, bronchoscopy with retrieval of large foreign body occluding trachea(Tamarind seed ) was done by Dr Swapnil Pattanshetti and anaesthesia by Dr. Purvashree Deshmukh , Dr Raghvendra kalal, Dr Shivpujimath .

Foreign body aspiration (FBA) is not very uncommon in the pediatric  population.  Its presentation can vary from a simple cough to dangerous pneumonia, or even rarely pneumothorax with surgical emphysema.  A  positive  history  and immediate  onset  of  respiratory  symptoms  and physical  findings  are  essential  for  diagnosis. However,  history  is  inconclusive  in  many instances,  or  the  child  may  present  late  after weeks  of  aspiration.

Bronchoscopy for removal of aspirated FB is an accepted gold standard. FB was of organic nature and was expected to be swollen up due to fluid absorption. Owing to prolonged retention of FB, formation of granulation tissue as well as difficult extraction was anticipated. Migratory FB has always posed unique danger of compromising healthy lung ventilation requiring urgent intervention. Such large FB occluding trachea with emphysema usually end up with tracheostomy and removal, but it was challenge to surgeon and anaesthetist to manage this case  with intermittent ventilation and complete bronchoscopic removal .

Our above patient, needed ventilation support for one day and discharged on post-operative day 4 without any O2 requirement and neurological deficits, doing well on 15 days follow up.  Patient and entire family was very much thankful for emergency surgical services, ICU care at KLE hospital.

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