Aerodigestive Foreign Body in Pediatrics: a Retrospective Study in Tertiary Hospital
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Date
2023-07
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Addis Ababa University
Abstract
Objective – The aim of this research is to assess the outcome and complications of aero digestive foreign body and associated risk factors in pediatric patients in Tikur Anbesa Specialized Hospital.
Method – The medical records of 302 children who were treated for an aero-digestive foreign body during a three-year period were reviewed at TASH. Patient’s demography (age, sex,adress),clinical data (Duration of symptoms, vomiting, dysphagia, cough ,fever, fast breathing,preoperative aspiration pneumonia,URTI), image finding, type of foreign body, type and length ofthe procedure, outcome, intra op and post-op complications ,rate of redo bronchoscopy procedurewere analyzed using logistic regression.
Results – The overall rate of removal of FBS in the 1st procedure was 97(95.1%) and 5(4.9%)pushed distally. 66(65.7%) removed with Magill’s forceps and esophagoscopy done in36(35.3%) .28(27.5%) develop complications. from this 20(19.6%) accounted for minimalesophageal mucosal bleeding during the procedure.4 cases(3.9%) have esophageal perforationand managed with chest tube and antibiotics.one case(2.9%)had TEF and 2 managedconservatively.one patient TEF repair through cervical approach. One patient died post esophagoscopic removal of battery from esophagus with hemorrhagic shock 2ndary to AEF.With mortality rate of (1%).In patents with FBA rigid bronchoscopy done in 195(97.5%) and direct laryngoscopy withMagill’s in 5(2.5%).FB removal was not successful in 24(12%) of patients, 1 in laryngoscopicgroup and 22 in bronchoscopy group. During the procedure 122(61%) develop complications,majority were intra operative complications like laryngospasm in 46(23%), persistent intraoperative hypoxia occurred in 93(46.5%), which was associated with intraop bradycardia in43(21.5%) and intraoperative cardiac arrest in 9(4.5%). Minimal bleeding from the air waymucosa occurred in 13(6.5%) during the procedure. But there was significant bleeding from theair way and death in one patient during removal of sharp FB.in 12 (6%) of patients there was pusin the air way during removal of airway FB in 9(4.5%) pneumothorax occurred in 9(4.5%) ofcases .one patient (0.5%) came with pneumothorax preoperatively. two patients had pneumomediastinum, Five (2.5%) develop BPF.72 (36%) had air way edema, 17(8.5%)developed HAP,. One patient (0.5%) develop HIE during the procedureOur analysis showed in patients with air way FB presence of preoperative infections (AOR 3.086;95% CI, 1.486; 6.41, P=0.003 and desaturation at presentation (AOR 5.52; 95% CI, 2.555-11.925;P=0.000), had increased risk of complications .patients with complication had prolonged hospitalstay (AOR 3.661; 95% CI, 1.327-10.104; P=0.012). Delayed presentation (>24 hours) (AOR23.135; 95% CI, 4.44-120.54; P=0), sharp and battery foreign bodies (AOR 50.803; 95% CI,5.742-449.49; P=0) were independent risk factors for occurrence of complications in esophagealFB.
Conclusion – In patients with air way FB presence of preoperative infection and desaturation at presentation had increased risk of complications with significant association .patients with complication had prolonged hospital stay .Delayed presentation (>24 hours),sharp and battery foreign bodies radiolucent FB on imaging, were independent risk factors for occurrence of complications in esophageal FB in children.
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Foreign body aero-digestive children outcome