• Users Online: 484
  • Print this page
  • Email this page


 
 
Table of Contents
CASE REPORT
Year : 2021  |  Volume : 18  |  Issue : 5  |  Page : 39-41

Foreign body (safety pin) in airway in a 2-month-old baby


Department of ENT- Head Neck Surgery, Apollo Hospitals, Bhubaneswar, Odisha, India

Date of Submission11-May-2021
Date of Acceptance07-Jun-2021
Date of Web Publication19-Jul-2021

Correspondence Address:
Surya Kanta Pradhan
Department of ENT- Head Neck Surgery, Apollo Hospitals, 251, Sainik School Road, Unit-15, Bhubaneswar - 751 005, Odisha
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_35_21

Rights and Permissions
  Abstract 


Respiratory tract foreign bodies are most dangerous emergencies in children. There are various types of foreign bodies removed from airway like-peanuts, metallic foreign bodies, sharp foreign bodies, led bulbs and different part of toys. Most commonly they present with proper history of aspiration and symptoms of respiratory distress, but not always. It should be diagnosed immediately either with the history and clinical examination or with the help of radiological investigations. High resolution computed tomography of chest gives the exact location of the foreign body. These patients should be managed promptly to reduce the morbidity and mortality. Rigid bronchoscopy with optical forceps under general anaesthesia is the procedure of choice to retrieve the foreign bodies. We are presenting a case of 2 months old child which has aspirated a safety pin into her airway accidentally. The location was confirmed by HRCT chest and it was removed using optical forceps. Child was discharged under stable conditions.

Keywords: 2-month-old child, Foreign body bronchus, high-resolution computed tomography Chest, safety pin


How to cite this article:
Pradhan SK. Foreign body (safety pin) in airway in a 2-month-old baby. Apollo Med 2021;18, Suppl S1:39-41

How to cite this URL:
Pradhan SK. Foreign body (safety pin) in airway in a 2-month-old baby. Apollo Med [serial online] 2021 [cited 2022 Sep 30];18, Suppl S1:39-41. Available from: https://apollomedicine.org/text.asp?2021/18/5/39/321830




  Introduction Top


Otorhinolaryngologists handle different types of foreign bodies (FBs) in their daily practice. Ear and nasal FBs encountered very frequently but FBs in airway are rare and dangerous. It is mostly seen in toddlers and presents with definitive history and symptoms of aspiration. The most common presenting features are respiratory distress and stridor. This condition should be diagnosed and managed as soon as possible to save the life of the patient. We are presenting a case of safety pin which was aspirated into the airway of a 2-month-old baby which was managed successfully with optical forceps.


  Case Report Top


A 2-month-old female patient presented to the Emergency department of Apollo Hospitals, Bhubaneswar, with a history of foreign body ingestion. Her mother was cleaning her nose with the safety pin and accidentally it slipped into her mouth. She tried to retrieve it but it slipped into the airway. On examination, she was having difficulty in breathing, intercostal indrawing, high respiratory rate, and normal pulse rate and other parameters were normal. Her saturation was around 90 and on auscultation, there was decreased air entry with added sound [Figure 1] and [Figure 2]. Urgent high-resolution computed tomography (HRCT) scan was done to diagnose and localize the FB. It was found to be just above the carina and partially blocking both the bronchus.
Figure 1: High-resolution computed tomography chest coronal view showing the safety pin

Click here to view
Figure 2: High-resolution computed tomography chest sagittal view showing the safety pin

Click here to view


Her parents were explained the situation and planned for rigid bronchoscopy and foreign body removal. As the child is very small and her airway diameter was very narrow, we could not negotiate the sheath of the bronchoscope. She was desaturating very fast because of the narrow airway and location of the foreign body just above the carina. Then we have planned to go with the optical forceps only but the risk was that if there will be any bleeding then it will be very difficult to manage. With apnea technique, we were successful in retrieving the safety pin in second attempt without any bleeding [Figure 3] and [Figure 4]. Check bronchoscopy was done and there was no fragment of FB left. The child was ventilated for few hours and discharged after 1 day under stable conditions. She came for follow-up after 1 week and was doing well.
Figure 3: Safety pin after removal

Click here to view
Figure 4: Intra operative picture showing optical forceps holding the safety pin

Click here to view



  Discussion Top


Foreign body in Ear nose and throat is very commonly encountered condition but airway FBs are rare. Aerodigestive tract FBs are mainly seen in children of age group 1–3 years.[1] As they tend to put everything in their mouth. They have very poor cough reflex and less dentition with lack of coordination while chewing. It is rarely seen in children below 6 months and very rare in the age of 2 months as they cannot grasp and put anything in mouth. Most of the cases are accidental insertions by sibling.

Most of the patients present with a proper history of FB aspiration but sometimes it's missing as they develop respiratory distress while playing alone or with their siblings.[2],[3] The degree of obstruction depends upon the site of obstruction and size of the FB. Most of the big FBs like coin or battery are lodged in hypopharynx and can be removed by simple manoeuvres like back blows.[4] Relatively small FBs can migrate to the airway if manipulated by someone or child develops sudden cough after aspiration and gets stuck in the laryngopharynx. Small FBs can cross the larynx and get impacted in lower airways, the right main bronchus being the most common site.[5] Some literature says the incidence is equal or more in the left bronchus.[6] FBs can be living or nonliving.[7] Nonliving FBs can be divided into vegetative and nonvegetative. Peanut with or without shell is the most common FB in children.[8]

Other FBs can be part of toys, battery, pins, screws, and pieces of coconut. Battery is the most dangerous FB as it can leak and release alkaline material causing severe tissue reaction and corrosion. Vegetative FBs can react with the tissue and form granulations around it and can cause complete obstruction. Sharp FBs and open safety pins are very dangerous as they can tear the airway and may lead to pneumothorax.

Different FBs present differently. The presenting features are-stridor, respiratory distress, whistling sound, and sometimes with features of pneumonia and asthma.[9] If there is any clinical suspicion of FB with or without proper history then we should go for X-ray chest/HRCT Chest. Computed tomography scan gives better information about the FB and exact site of the lodgement. Rigid bronchoscopy with optical forceps under general anesthesia is the gold standard for diagnosis and management of FB airway. Sometimes flexible laryngoscopy can be used in selective cases mainly in adults.[10] Once the diagnosis is made the bronchoscopy procedure should be carried out immediately to save the life of the patient. Most of the time the FB can be retrieved. Check bronchoscopy should be done to rule out any remnants. If the child is stable can be discharged on the same day but some children require few hours of mechanical ventilation. The morbidity and mortality are negligible if the procedure is done in proper time. If it is not addressed in proper time sever complications even respiratory arrest can happen.[11] Follow-up is always advisable for 6 months to avoid any long-term complications.


  Conclusion Top


Foreign body bronchus is a rare entity and at the age of 2 years is very rare. Although the history of FB aspiration is not always obvious can be derived in most of the cases. High degree of suspicion is always warranted in case of acute onset of respiratory difficulties, especially in toddlers. These emergencies should be managed promptly to save the life of the patient. Rigid bronchoscopy with optical forceps is the gold stand for diagnosis and management of FB airway. All the parents should be educated to prevent such incidences.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Narasimhan KL, Chowdhary SK, Suri S, Mahajan JK, Samujh R, Rao KL. Foreign body airway obstructions in childrenlessons learnt from a prospective audit. J Indian Assoc Pediatr Surg 2002;7:184-9.  Back to cited text no. 1
  [Full text]  
2.
Abder-Rahman HA. Infants choking following blind finger sweep. J Pediatr (Rio J) 2009;85:273-5.  Back to cited text no. 2
    
3.
Kuo CL. Management strategies for ingestion of foreign objects in the laryngopharynx. J Oto Rec Surg 2015;1:110.  Back to cited text no. 3
    
4.
Gencpinar P, Duman M. Importance of back blow maneuvers in a 6 month old patient with sudden upper airway obstruction. Turk J Emerg Med 2015;15:177-8.  Back to cited text no. 4
    
5.
Saki N, Nikakhlagh S, Heshmati SM. 25-year review of the abundance and diversity of radiopaque airway foreign bodies in children. Indian J Otolaryngol Head Neck Surg 2015;67:261-6.  Back to cited text no. 5
    
6.
Zur KB, Litman RS. Pediatric airway foreign body retrieval: Surgical and anesthetic perspectives. Pediatr Anesthesia 2009;19:109-17.  Back to cited text no. 6
    
7.
Raju S, Jhawar P. Live fish in the endobronchial tree. J Bronchology Interv Pulmonol 2015;22:175-7.  Back to cited text no. 7
    
8.
Ganie FA, Wani ML, Ahangar AG, Lone GH, Singh Sh, Lone H, et al. The efficacy of rigid bronchoscopy for foreign body aspiration. Bull Emerg Trauma 2014;2:52-4.  Back to cited text no. 8
    
9.
Tan HK, Brown K, McGill T, Kenna MA, Lund DP, Healy GB. Airway foreign bodies (FB): A 10-year review. Int J Pediatr Otorhinolaryngol 2000;56:91-9.  Back to cited text no. 9
    
10.
Mise K, Jurcev Savicevic A, Pavlov N, Jankovic S. Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: Experience 1995–2006. Surg Endosc 2009;23:1360-4.  Back to cited text no. 10
    
11.
Aissaoui A, Salem NH, Chadly A. Unusual foreign body aspiration as a cause of asphyxia in adults: An autopsy case report. Am J Forensic Med Pathol 2012;33:284-5.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1041    
    Printed48    
    Emailed0    
    PDF Downloaded44    
    Comments [Add]    

Recommend this journal