Presentation And Management Of Neglected Inhaled Foreign Body At Sohag University Hospital

Overview

Delayed presentation is not uncommon in children and may have been treated as asthma due to associated with low-grade cough and noisy breathing. Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days after the aspiration of the foreign body, or onset of symptoms. Undiagnosed foreign body aspiration can cause mechanical effects, chemical reactions, and the most common complications were pneumonia, asthma, lung collapse, bronchiectasis, emphysema, mediastinal shift, atelectasis and lung abscess. Long-term presence of FBs in the bronchus may lead to bronchial stenosis

A foreign body is an endogenous or exogenous substance, different from the anatomy of the site where it is found. Chevalier Jackson defined a foreign body as "an object or a substance that is foreign to its location". Aspiration of a foreign body (FB) is a potentially life-threatening emergency and 75% of cases occur in children younger than 3 years of age, due to the absence of molar teeth, underdeveloped swallowing coordination and the tendency to talk and play while eating . However, foreign body aspiration does happen in adults and elderly people as well. Obtaining a good history plays a vital role in effectively diagnosing a foreign body aspiration. Three clinical phases of aspiration of foreign bodies are recognized: The first stage is the impaction of the foreign body and entitled "penetration syndrome," defined as a sudden onset of choking and intractable cough with or without vomiting. In the second stage, these symptoms diminish as the foreign body settles into a stationary location and the tracheoesophageal reflexes tire out; this asymptomatic stage can last hours to weeks, which may delay diagnosis. In the third phase, Complications occur (also defined as Complications phase), when obstruction, erosion or infection cause pneumonia, atelectasis, abscess or fever. The first presentation of the condition may actually represent a complication of inhaled foreign body. Delayed presentation is not uncommon in children and may have been treated as asthma due to associated with low-grade cough and noisy breathing. Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days after the aspiration of the foreign body, or onset of symptoms. Undiagnosed foreign body aspiration can cause mechanical effects, chemical reactions, and the most common complications were pneumonia, asthma, lung collapse, bronchiectasis, emphysema, mediastinal shift, atelectasis and lung abscess. Long-term presence of FBs in the bronchus may lead to bronchial stenosis. Neglected foreign bodies in the respiratory tract may occur due to misdiagnosis by the fellow professionals and pediatricians when FBs in the upper tracheal airway produce symptoms similar to those of viral subglottic croup or due to lack of typical symptoms and signs. The most common symptoms and signs of FBA, namely coughing, wheezing, and decreased air entry, can easily be overlooked by bronchial asthma or pneumonia. Parental negligence, not conclusive chest radiographs, and false negative bronchoscopic findings are other blamed factors