Unusual Foreign Body Aspiration in a 12 Year old Boy

JK. Patra*^a (Dr), M. Pattanaik^a (Prof), OK. Jha^a (Dr)

^a DEPARTMENT OF PULMONARY MEDICINE, SCBMCH, Cuttack, INDIA

* jeetendrakumarpatra@gmail.com

Introduction:

Foreign-body aspiration is a relatively common occurrence in children. It may present as a acute respiratory failure which is life-threatening that requires invasive mechanical ventilation followed by prompt removal of the foreign body.

Case Report:

A 12 years old boy presented with cough and breathlessness of acute onset. On enquiring parents gave a history of live fish aspiration while the boy was playing with it. In view of respiratory failure, patient was admitted to Respiratory ICU and put on invasive mechanical ventilation after intubating with a 7mm sized endotracheal tube under midazolam. In spite of volume control ventilation with FiO₂ of 100%, the patient hardly achieved SpO₂ of 85%. Fibreoptic bronchoscopy was carried out through endotracheal tube and observed right main bronchus intubation. The endotracheal tube was repositioned at 2cm above the carina and gradually SpO_2, heart rate and respiratory rate stabilised. A shiny foreign body was seen blocking the left main bronchus. After two hours again the patient desaturated and developed tachycardia, hypotension and tachypnea. Again the Bronchoscope was reintroduced through endotracheal tube, a fenestrated cup biopsy forcep was introduced, the foreign body was catched and removed along with the scope. Unusual foreign body was found to be a fish grasped at its mouth end.

Conclusion:

In emergency conditions and during odd hours, fibreoptic bronchoscopy with usual accessories may help for removal of foreign body and save life.

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