Mehmet YILDIRIM, Tamer OKAY, Recep USTAALİOĞLU, Rüçhan ANBAR, Halit YARDIMCI, Ilgaz DOĞUSOY, Hatice DEMİRBAĞ

Tracheobronchial foreign bodies: a review of 787 cases

Amaç: Bu çalışmada kliniğimize yabancı cisim şüphesi ile başvuran hastaların tanı ve tedavi yöntemleri değerlendirildi ve sonuçlar tartışıldı.Ça lış ma pla nı: Ocak 1982 - Aralık 2012 tarihleri arasında göğüs cerrahisi kliniğimizde yabancı cisim şüphesi ile endoskopik işlem uygulanmış 787 hastanın (353 erkek, 434 kadın; ort. yaş 11.7 yıl; dağılım 5 ay-85 yıl) verileri retrospektif olarak incelendi. Yaş, cinsiyet, klinik semptomlar, yabancı cismin bronşiyal ağaçtaki yerleşim yeri, radyolojik bulgular, yabancı cismin türü, yabancı cisim aspirasyonu ile çıkarılış zamanı arasındaki süre, komplikasyonlar ve mortalite oranları değerlendirildi.Bul gu lar: Erkek-kadın oranı 1:1.2 idi. Olguların %13.7'sinde (n=108) bronkoskopi ile yabancı cisim bulunmadı (yabancı cisim gerçekte yok+periferal yerleşimli yabancı cisim). Olguların %83.2'si (n=655) bronkoskopi ile çıkartıldı. Yabancı cismin çok periferde olduğu veya cismi forsepsin tutamadığı 35 olgu (%4.4) torakotomi+bronkotomi ile çıkartıldı. Yabancı cisim/cisimlerin çıkarıldığı toplam olgu sayısı 690 idi. Çıkarılan yabancı cisimlerin %43.9'u iğne, %27.2'si kuruyemiş ve %28.9'u diğer yabancı cisimler idi. Aspire edilen yabancı cisimlerin %52.2'si sağ, %32.2'si sol bronşiyal sistemde, %13.9'u trakeada ve %1.7'si her iki bronşiyal sistemde yerleşimli idi. Komplikasyon oranı %3.3 idi ve dört hasta kaybedildi.So nuç: Trakeobronşiyal yabancı cisimler özellikle 0-3 yaş grubunda diğer yaş gruplarına kıyasla daha sık erken ve geç komplikasyonlara neden olarak hayatı tehdit edebilir. Trakeobronşiyal yabancı cisim aspirasyonu sıklığının eğitim ile azalmasını umut etmekteyiz.

Trakeobronşiyal yabancı cisimler: 787 olgunun değerlendirilmesi

Background: This study aims to evaluate the diagnoses and treatment methods of patients who applied to our clinic with suspected foreign body and discuss the results.Methods: Data of 787 patients (353 males, 434 females; mean age 11.7 years; range 5 months to 85 years) who were performed endoscopic procedure due to suspected foreign body in our thoracic surgery clinic between January 1982 and December 2012 were retrospectively reviewed. Age, sex, clinical symptoms, localization of foreign body in the respiratory tree, radiological findings, nature of the foreign body, time lapse between foreign body aspiration and removal, complications, and mortality rates were evaluated.Results: Male to female ratio was 1:1.2. In 13.7% of the cases (n=108), foreign body was not found by bronchoscopy (true absence of foreign body+peripheral localization of foreign body). Of the cases, 83.2% (n=655) was removed by bronchoscopy. Thirty-five cases (4.4%) with bodies located too peripherally or which could not be grasped by forceps were removed via thoracotomy+bronchotomy. Total number of cases with removed foreign body/bodies was 690. Of the removed foreign bodies, 43.9% was pins, 27.2% was nuts, and 28.9% was other foreign bodies. Of the aspirated foreign bodies, 52.2% was localized in the right and 32.2% in the left bronchial systems, 13.9% in trachea, and 1.7% in both bronchial systems. Complication rate was 3.3% and there were four mortalities.Conclusion: Tracheobronchial foreign bodies may be lifethreatening particularly in the 0-3 age group by causing more frequent early or late complications compared to other age groups. We hope that the frequency of tracheobronchial foreign body aspirations decrease through means of education.

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Shields TW. Management of foreign bodies of the airway. In: Wei JL, Holinger LD, editors. General Thoracic Surgery. 7th ed. Phileadelphia: Lippincott Williams & Wilkins; 2009. p. 927-36.
Brown TC, Clark CM. Inhaled foreign bodies in children. Med J Aust 1983;2:322-6.
Menéndez AA, Gotay Cruz F, Seda FJ, Vélez W, Trinidad Pinedo J. Foreign body aspiration: experience at the University Pediatric Hospital. P R Health Sci J 1991;10:127-33.
Kiyan G, Gocmen B, Tugtepe H, Karakoc F, Dagli E, Dagli TE. Foreign body aspiration in children: the value of diagnostic criteria. Int J Pediatr Otorhinolaryngol 2009;73:963-7.
Darrow DH, Hollinger LD. Foreign bodies in the larynx, trachea, and bronchi. In: Bluestone CD, Stool S,Kenna MA, editors. Pediatric Otolaryngology. Philadelphia: W.B. Saunders; 1996. p. 1390-401.
Mu L, He P, Sun D. Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope 1991;101:657-60.
Carluccio F, Romeo R. Inhalation of foreign bodies: epidemiological data and clinical considerations in the light of a statistical review of 92 cases. Acta Otorhinolaryngol Ital 1997;17:45-51. [Abstract]
Puhakka H, Kero P, Valli P, Iisalo E, Erkinjuntti M. Pediatric bronchoscopy. A report of methodology and results. Clin Pediatr (Phila) 1989;28:253-7.
Mantel K, Butenandt I. Tracheobronchial foreign body aspiration in childhood. A report on 224 cases. Eur J Pediatr 1986;145:211-6.
Kanca A, Doğusoy I, Akgül M, Doğusoy G, Trakeobronşial yabancı cisimler. Pediatrik Cerrahi Dergisi 1990;4:111-4.
Yıldırım M, Doğusoy I, Okay T, Yaşaroğlu M, Demirbağ H, Aydemir B, ve ark. Trakeobronşial yabancı cisimler", Turk Gogus Kalp Dama 2003;11:228-31.
Bhatia PL. Problems in the management of aspirated foreign bodies. West Afr J Med 1991;10:158-67.
Mu LC, Sun DQ, He P. Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases. J Laryngol Otol 1990;104:778-82.
Girardi G, Contador AM, Castro-Rodríguez JA. Two new radiological findings to improve the diagnosis of bronchial foreign-body aspiration in children. Pediatr Pulmonol 2004;38:261-4.
Gallardo LCH, Barragán MS, Sánchez MDE, García AA. Delayed diagnosis of foreign body aspiration. Bol Med Hosp Infant Mex 2011;68:202-5.
Ciftci AO, Bingöl-Koloğlu M, Senocak ME, Tanyel FC, Büyükpamukçu N. Bronchoscopy for evaluation of foreign body aspiration in children. J Pediatr Surg 2003;38:1170-6.
Karakoc F, Cakir E, Ersu R, Uyan ZS, Colak B, Karadag B, et al. Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms. Int J Pediatr Otorhinolaryngol 2007;71:241-6.
Sersar SI, Rizk WH, Bilal M, El Diasty MM, Eltantawy TA, Abdelhakam BB, et al. Inhaled foreign bodies: presentation, management and value of history and plain chest radiography in delayed presentation. Otolaryngol Head Neck Surg 2006;134:92-9.
Cohen S, Avital A, Godfrey S, Gross M, Kerem E, Springer C. Suspected foreign body inhalation in children: what are the indications for bronchoscopy? J Pediatr 2009;155:276-80.
Daines CL, Wood RE, Boesch RP. Foreign body aspiration: an important etiology of respiratory symptoms in children. J Allergy Clin Immunol 2008;121:1297-8.
Puhakka H, Kero P, Erkinjuntti M. Pediatric bronchoscopy during a 17-year period. Int J Pediatr Otorhinolaryngol 1987;13:171-80.
Mantor PC, Tuggle DW, Tunell WP. An appropriate negative bronchoscopy rate in suspected foreign body aspiration. Am J Surg 1989;158:622-4.
Saquib Mallick M, Rauf Khan A, Al-Bassam A. Late presentation of tracheobronchial foreign body aspiration in children.J Trop Pediatr 2005;51:145-8.
Inglis AF Jr, Wagner DV. Lower complication rates associated with bronchial foreign bodies over the last 20 years. Ann Otol Rhinol Laryngol 1992;101:61-6.
Zaytoun GM, Rouadi PW, Baki DH. Endoscopic management of foreign bodies in the tracheobronchial tree: predictive factors for complications. Otolaryngol Head Neck Surg 2000;123:311-6.
Paşaoğlu I, Doğan R, Demircin M, Hatipoğlu A, Bozer AY. Bronchoscopic removal of foreign bodies in children: retrospective analysis of 822 cases. Thorac Cardiovasc Surg 1991;39:95-8.
Lima JAB, Fischer GB, Penna C. Sequelae of foreign body aspiration in the respiratory tract of children. J Pneumol 2000;26:20-4.
Mounier-Kuhn A, Morgon A, Gregoire D, Romanet P. Emergency treatment of tracheal and bronchial foreign bodies. Ann Anesthesiol Fr 1976;11:837-41. [Abstract]