Bronchoscopic removal of aspirated foreign bodies in children.

Foreign body aspiration is the cause of death for more than 300 children each year in the United States. Tracheobronchial inhalation of foreign bodies may result in acute respiratory distress, atelectasis, chronic pulmonary infections, or death. A review of the records of 548 children (aged 4 months to 18 years) was undertaken to identify factors important in diagnosis, to illustrate the effectiveness of current endoscopic techniques and equipment, and to evaluate the results and complications of management. Coughing, choking, and wheezing were the presenting symptoms seen for 95% of the patients. Results of inspiratory and expiratory chest radiographs were positive in 83% of the 440 children who had foreign bodies removed. Fluoroscopy findings were positive for 67 patients, 90% of whom had foreign bodies removed. Foreign bodies were successfully identified and removed in 440 patients (80%). A wide variety of objects was recovered, the most common being peanuts, organic material, other nuts, popcorn, seeds, plastic objects, and pins. The foreign bodies were in the right bronchus in 49%, the left in 44%, and the trachea and hypopharynx in 4%. Two thirds of the objects were lodged in the mainstem bronchi, on either side, and the remainder were in the distal bronchi. Bronchoscopy is required for treatment, and with experience this procedure can be simple and safe. Ninety-nine percent of the foreign bodies identified during bronchoscopy were removed successfully. Minor complications occurred in 5%, and there were no deaths.