Yield of diagnostic rigid bronchoscopy in children

ABSTRACT

To highlight yield of rigid bronchoscopy in cases of suspected foreign body [FB] tracheobronchial tree [TBT] in children. This is a prospective analytical study of 78 cases, conducted in the E.N.T-Head and Neck Surgery department of Post Graduate Medical Institute [PGMI], Hayatabad Medical Complex Peshawar during six years i.e. from April 2000 to March 2006. All patient underwent rigid bronchoscopy for removal of suspected inhaled foreign body [FB] from tracheobronchial tree. Cases included were of paediatric age group [12 years and below] and of either sex. Out of total 78 cases 42 were male and 36 were female with male to female ratio of 1. 71. All patients were of paediatric age group [12 years and below]. The eldest patient was of 12 years and the youngest was two months of age. Most of the patients [47%] were referred from paediatric units of this hospital. Twelve cases [15%] were referred from other hospitals. Nineteen [24%] cases were referred through casualty while another 10 patients [13%] came directly through OPD. Twenty three patients [29%] were Afghani nationals. All 78[100%] cases underwent rigid bronchoscopy on the basis of suspicion of inhalation of FB. In [13%] cases history of inhalation of FB was obtained retrospectively after successful procedure. In the remaining 77% cases it was the failure to respond to medical treatment that lead to referral for the procedure. In 62% cases FB was recovered on bronchoscopy while in 38% cases no FB was found. Other pathologies were recorded in 18% cases while 20% cases bronchoscopy yielded no FR or other pathology Right main bronchus was the most common site where FB was lodged [42% cases] followed by left main bronchus [28% cases], smaller bronchiole on right side [18% cases] and smaller bronchiole on left side [12% cases]. No FB was found in trachea or subglottic area. 75 patients [96%] had complete removal of FBs with first intervention. Only 3 [4%] cases a second attempt was required. One [1.3%] mortality occurred in the study. Over all complication rate recorded was 7%. It was included that index of suspicion should be kept very high in all cases presenting with respiratory symptoms not responding to medical treatment or those with recurrence of symptoms. All such patients should undergo rigid bronchoscopy