Non-vegetable foreign bodies in the bronchopulmonary tract in children.

A variety of 40 cases of non-vegetable foreign bodies inhaled by children are presented. These include: coins, washers, pins, reamers, nails, screws, wires, pencil caps, ball-point tip, worry beads, bones, broken tooth, small stones, and blades of broken foreign body forceps. The ages of the children ranged between 10 months and 8 years with average at 2 years and 9 months. Two methods are described for the removal of slippery beads, using a Fogarty Catheter and foreign body forceps technique. Emphasis is placed on the importance of bronchoscopy in all cases with definite or doubtful history of foreign body inhalation in spite of negative physical or roentgenological findings, particularly those cases diagnosed as upper respiratory infection, pneumonitis, bronchial asthma and whooping cough, and when there is no significant response to such treatment. Fluoroscopy with image intensifier is suggested for the localization of the pointed end of sharp pins which cannot be identified clearly through the bronchoscope. General anaesthesia was used in all the cases to ensure absolute immobility. Repeated bronchoscopies at close intervals were not advised and tracheostomy was suggested in subglottic oedema if asphyxia is threatening the life of the child. Immediate removal of foreign bodies is important so as to avoid unnecessary complications. Lobectomy was necessary in one case with an impacted screw and destroyed lobe. This stresses the importance of thoracotomy when several attempts fail to remove the foreign body.