International Journal of Pediatric Otorhinolaryngology Extra
Volume 6, Issue 1 , Pages 33-35, January 2011

Multiple factors responsible for fatal outcome in 14-month-old child with 4.5cm right angled metallic nail in the bronchus

  • N.N. Mathur

      Affiliations

    • Department of Otorhinolaryngology and Head and Neck Surgery, B P Koirala Institute of Health Science, Dharan, Nepal
    • Corresponding Author InformationCorresponding author at: Department of Pediatric Otolaryngology, Chacha Nehru Bal Chikitsalaya - Pediatric Hospital, affiliated to Maulana Azad Medical College, Geeta Colony, Delhi, India. Tel.: +91 11 22378498.
    • ,
  • Anand Ghimire

      Affiliations

    • Department of Otorhinolaryngology and Head and Neck Surgery, B P Koirala Institute of Health Science, Dharan, Nepal
    • ,
  • Rupesh Raj Joshi

      Affiliations

    • Department of Otorhinolaryngology and Head and Neck Surgery, B P Koirala Institute of Health Science, Dharan, Nepal
    • ,
  • Laxmi Pathak

      Affiliations

    • Department of Anaesthesiology and Critical Care, B P Koirala Institute of Health Science, Dharan, Nepal

Received 1 October 2009; received in revised form 11 January 2010; accepted 12 January 2010. published online 11 February 2010.

Abstract 

We report a child who died after an attempt to remove a 4.5cm metallic angled nail from the bronchus of an 18-month-old child. This case highlights a number of problems which can complicate foreign body extraction in small children:

•Delayed diagnosis: often misdiagnosed as asthma.

•Sudden deterioration: no time to plan approach.

•Minimal stridor may be present with low airflow.

•Intubation: this risks distal dislodgement of foreign body.

•Laryngeal lumen in children under 18 months will often not accept optical forceps.

•Edema from manipulation worsens an already precarious situation.

The sudden deterioration requiring intubation was the critical point in this case. If at all possible intubation should be avoided.

Keywords: Foreign body, Nail, Bronchus, Child

 

PII: S1871-4048(10)00005-5

doi:10.1016/j.pedex.2010.01.003

International Journal of Pediatric Otorhinolaryngology Extra
Volume 6, Issue 1 , Pages 33-35, January 2011

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