Management of Foreign Body Aspiration in Pediatric Patients: An Experience from a Tertiary Hospital in Ethiopia

Background: Accidental foreign body aspiration is a relatively common occurrence in pediatric patients and may result in asphyxiation and death, especially among those aged less than 4 years. This study was aimed at analyzing the clinical and radiological profile, modes of managements and outcomes of foreign body aspiration in children in a tertiary care center and identify areas of possible interventions for proper management of such cases.
Method: This was a 2-year retrospective study of children who were admitted and treated for foreign body aspiration between 1 September 2012 and 30 August 2013 at the paediatric surgery unit of Tikur Anbesa Specialized Hospital (TAH) in Ethiopia. Case records of patients suspected to have foreign body aspiration over the past two years were analyzed. Clinico-radiological features, types and location of foreign bodies, modes of management and patients outcomes were studied.
Results: A total of 81 children underwent rigid bronchoscopic evaluation, and foreign bodies were identified and removed in 76(93%) of the cases.The mean age of the patients was 4.6 yrs (5 months to 11 years), 54 (71.1%) were male and 22 (28.9%) were female. A foreign body aspiration history obtained in 58 (76.3%) of the patients, The mean duration of illness was 1.6 +1.9 days with range of 4.5 hours and 4 months, majority of patients, 29 (38.2%) were from Oromia region; 14 (18%) reported within 24 hours of the event; plastic tips was retrieved in 17 (22.4%) patients, seed in 15(19.7%), balloon inflator tip in 7(9.2%), metallic tips 5 (6.6%), Hijab pin 2(2.6%); 50 (73.7%) presented with cough, shortness of breath in 38(50%), wheeze in 23(30.3%);chest x-ray common findings were 10(13.2%) lobar pneumonia, 8 (10.5%) radio opaque foreign body, 7(9.2%) hyperinflation, and 4(5.3%) pneumonia; The site of foreign body lodgment is right main bronchus in 44 (57.9%) patients followed by left main bronchus in 20 (26.3%), trachea in 11(14.5%) and lower stem bronchus in 1 (1.3 %);73(96%) cases had smooth course in the hospital and discharged within 10 days after bronchoscopic procedures and individualized medical care. 1(1.3%)has passed away.
Conclusion: Foreign body aspiration remains a common unintentional childhood injury. Rigid bronchoscopy is very effective procedure for the removal of aspirated foreign body with fewer complications. Education is the best preventive measure for decreasing the incidence of this problem. Caring physician should maintain high index of clinical suspicion to avoid fatal outcome and long term morbidity. Bronchoscopic facility should be available at all hospitals.