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

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.

Keywords: Aerodigestive tract; Aspiration; Foreign body; Impaction; Ingestion.

Figure 1

Bar chart of age grouping versus aspiration or ingestion

Figure 2

a) AP and lateral CXR shows whistle-valve in left main bronchus b) Whistle-valve retrieved

Figure 3

a) AP and lateral CXR – LED bulb element in right main bronchus with atelectasis of middle and lower lobes. b) LED bulb retrieved (right), prototype (left).

Figure 4

a) AP CXR - round radio-opaque object in proximal oesophagus. b) Disc-battery retrieved