Bronchoscopy-proven bilateral broncheal foreign bodies aspiration presenting as life-threatening obstructive airway disease: A retrospective study of 40 cases

Objectives: evaluation of clinical spectrum of bronchoscopy proven bilateral broncheal foreign bodies: diagnostic and therapeutic efficacy of bronchoscopy. methods: a retrospective descriptive clinical study in a tertiary care centre from june,2000 to july,2015 included 40 paediatric patients aged 6 months to 8 years with aspiration. bronchoscopy was done in all of these patients under general anesthesia. all the patients were subjected to history taking,clinical examination & investigations (pre and post-op x-ray chest) and diagnostic/therapeutic bronchoscopy. results: the commonest age of presentation was 1 -3 years,mostly presenting within 18 hours of aspiration. 50% of the patients presented with history of aspiration,breathlessness refractory to medical therapy (50%) with cough (60%),cyanosis/desaturations (65%) and bilateral decreased air entry(6o%) being the most common presentation. emphysema was the most common finding on x-ray chest (80%). sensitivity of bronchoscopy was 100%. majority of the foreign bodies were organic (95%- beetle nuts and peanuts).post-op complications were rare (laryngospasm and bronchospasm) and were managed conservatively. none of the patients required a tracheostomy and there was zero mortality. conclusions: a positive history is by itself is an indication for bronchoscopy. clinical signs and x-ray changes should guide the clinician towards the possible location of the foreign body. bronchoscopy can be done in suspected cases with no specific history or in children with severe acute respiratory distress refractory to the conservative management. diagnostic and therapeutic bronchoscopy can be done with minimal complications when performed by coordination of expert surgeon and anesthetist. © 2015,pakistan pediatric journal. all rights reserved.