Volume 3, Issue 1 , Pages 28-30, January 2008
Threading a bead in trachea—A case report
Article Outline
Summary
A rare case of a rounded bead, as a foreign body, in the trachea is mentioned. Unusual presentation is described. Fogarty balloon catheter is used to thread the bead and to extract without damaging tracheal mucosa.
Keywords: Foreign body, Bronchoscopy, Fogarty balloon catheter
1. Introduction
Foreign body aspiration is potentially serious and can sometimes have fatal consequences. It is always challenging for an otolaryngologists to remove the foreign bodies from the aero digestive tracts. More especially the rounded beads that is difficult to be grasped with conventional forceps during bronchoscopies. The use of a Fogarty balloon catheter, for the removal of these types of foreign bodies, is well established, although the use is rare as these foreign bodies are not very common. In fact, during the last 5 years we have not found any case literature on this subject. Here, we present another case of retrieval of globular foreign body from the trachea, with the help of Fogarty balloon catheter.
2. Case report
A 9-year-old child is presented to the emergency unit of otolaryngology with accidental insertion of a rosary bead.
Initially, there was a cough, and choking sensation, which settled later on. A whistling sound could be heard sometimes during respiration. Vitals were normal and there was no respiratory distress or cyanosis. Auscultation over the lower part of the neck and chest sometimes revealed an audible thump and whistling. X-rays, of the chest and neck, did not reveal any definite radio opaque shadow in the tracheobronchial tree. Rigid bronchoscopy was performed, under general anesthesia, which showed a globular bead with a central lumen, which was occasionally moving up and down in the trachea. The foreign body could not be grasped, as the ends were rounded, and its retrieval failed by usual method of foreign body removal. The gap between the tracheal wall and the edges of the foreign body was also very minimal, and thus a catheter could not bypass it. Threading the bead with a Fogarty balloon catheter was also not easy because of the movements of the foreign body. Finally, a Fogarty balloon catheter could be negotiated through the lumen, in the foreign body, and its balloon was inflated. The foreign body was trapped between the balloon and the bronchoscope tip and finally pulled out (Figure 1, Figure 2, Figure 3). Patient's post-operative period was uneventful and he was discharged from the hospital on the subsequent day.
Figure 1.
Foreign body (the bead).
Figure 2.
Threading the bead with Fogarty catheter.
Figure 3.
Inflating the balloon of Fogarty catheter and engaging the bead.
3. Discussion
Tracheobronchial foreign body is an emergency and needs bronchoscopic removal. This can be very troublesome: particularly with objects presenting issues with grasping/retrieving them. Foreign bodies in the tracheobronchial tree are more frequent in children under 3 years of age, and boys are more frequently involved than girls. Most of the time these foreign bodies are organic in nature and peanuts being the most common amongst them. These foreign bodies carry a mortality risk of little more than 1%, as a result of related complications [1]: Generally, tracheal foreign bodies produce immediate symptoms of obstruction and choking, but these symptoms are absent when the foreign body has a central lumen, thus not causing any respiratory obstruction [2]. Sometimes these foreign bodies are expelled out spontaneously [3], [4]. Most of the time it requires bronchoscopic removal. Various, usual and unusual, methods have been tried to remove these foreign bodies [5], [6]. Fogarty balloon catheter has also been used for retrieval of these foreign bodies when the traditional methods of grasping the foreign body has failed. It is used either by negotiating its tip between the edges of the foreign body and the lumen wall [7], [8]. Or by threading the catheter though the central lumen in the foreign bodies itself. However, this method is not very safe and complications have been reported during the use of Fogarty catheter for the removal of foreign bodies [9].
4. Conclusion
We have presented a case of a foreign body in the trachea. To our knowledge this is a rare presentation with a bead in the trachea, and the threading of this bead in the trachea, using a Fogarty catheter, was not well described in the literature before.
References
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- Spontaneous expulsion of unusual tracheobronchial foreign body. Ind. J. Pediatr. 2001;68(2):173–174
- . An unusual method for the removal of a foreign body from a child's airway. Pediatr. Emerg. Care. 2006 March;22(3):173–174
- . Endobronchial foreign body extraction: a new interventional approach. Chest. 2001 Oct.;120(4):1402–1405
- . The combined use of Fogarty balloon and extraction forceps for the controlled retrieval of and endobronchial foreign body. Int. J. Pediatr. Otorhinolaryngol. 2001;60(2):163–165
- . Bronchoscopic extraction of aspirated foreign bodies in children. Am. J. Dis. Child. 1982 Oct;136(10):924–927
- . A complication in the use of a Fogarty catheter for foreign body removal during bronchoscopic management. Otolaryngol. Head Neck Surg. 1981;89(6):998–1000
PII: S1871-4048(07)00074-3
doi:10.1016/j.pedex.2007.09.003
© 2007 Elsevier Ireland Ltd. All rights reserved.
Volume 3, Issue 1 , Pages 28-30, January 2008
