Flexible Bronchoscopic Removal of 3 Foreign Objects

Discussion

More than 50% of foreign bodies lodge at the right main stem bronchus due to the trachea’s anatomical position.^2,4 In adults, foreign-body aspiration may present with nonspecific symptoms, such as cough and dyspnea.⁴ Other symptoms might include wheezes, chest discomfort, and sputum production. A chest radiograph is helpful as part of the initial diagnostic workup. A chest CT scan without contrast should be performed to confirm the diagnosis and to plan possible foreign-body retrieval.

Bronchoscopy is the gold standard for diagnosis and management of foreign-body aspiration.¹ Rigid bronchoscopy is superior to flexible bronchoscopy in removal of large airway foreign bodies.¹ The rigid bronchoscopy provides the ability to function as an endotracheal tube, thus allowing control of the airway and a conduit through which foreign bodies can be removed.¹ Nonetheless, sometimes retrieval of foreign bodies deeper into the subsegmental bronchi cannot be achieved.¹ Moreover, the required equipment or knowledgeable staff is not always available.¹ Therefore, flexible bronchoscopy is an option to retrieve airway foreign bodies especially those located distal in the airway and for those medical centers without rigid bronchoscopy as is the case in our institution.

In our case, flexible bronchoscopy was performed in the OR because we predicted a difficult and prolonged retrieval in view of multiple and different-sized objects. Anesthesia Service assistance was requested anticipating need for patient sedation and intubation. We used the tripod and snare retrieval tools to remove 3 foreign objects located at the right main stem bronchus. Even though multiple attempts were made and endotracheal intubation was required, a successful retrieval with flexible bronchoscopy was performed. Moreover, cardiothoracic surgery was not required avoiding more invasive interventions with subsequent morbidity and mortality.

Conclusion

Flexible bronchoscopy is an important tool within the arsenal of the Pulmonology Service. The management of the underlying etiology also should be performed. In our case, the Psychiatry Service recommended that the patient’s medications should be administered by his mother to avoid similar events in the future. Flexible bronchoscopy can be a valuable option for foreign objects removal, especially those distally located in the lung segments as well as in those medical centers where rigid bronchoscopy is not available.