Foreign bodies in tracheobronchial tree in children: a review of cases over a twenty-year period.

BACKGROUND: Foreign body inhalation into the tracheobronchial tree of children is rather rare but serious problem. It may be hazardous and even cause fatal sequelae in the children if misdiagnosed and not managed promptly.
METHODS: We retrospectively reviewed the records of 81 patients with foreign bodies inhaled into the larynx, trachea and bronchi. The children were all treated during the 20-year period from July 1976 through June 1996 at Chang Gung Memorial Hospital. Of these patients, 82% were 36 months of age or younger. The male to female ratio was 3:1. All of the patients initially received flexible fiberoptic bronchoscopy to identify the foreign objects. The foreign bodies were removed by jet ventilation bronchoscopy with apneic techniques under general anesthesia.
RESULTS: Peanuts were found to be the most common causative foreign body agent which occurred in 53 instances (65%). The most common manifestation was coughing, with subsequent dyspnea and audible wheezing. The foreign bodies were lodged in the left bronchus more than in the right. The most obvious radiologic evidence observed in aspirated children were emphysematous changes at same side of the foreign bodies caused by "expansile check-valve" phenomenon. Four patients showed radio-opaque objects on chest roentgenograms. Six patients required second extraction procedures due to the retained foreign bodies. Neither serious complications nor deaths occurred in these patients due to the foreign body inhalation.
CONCLUSION: Early diagnosis and management is essential in children with foreign bodies in the airways to prevent morbidity or death. Small materials or food bits should be kept far away from young child.