Aspirative foreign body converted in ingested foreign body (página 2)
Discusion
The physical actions of the epiglottis and arytenoid
cartilages is to block the airways.the laryngeal intensive spasm
provocated by objets getting near the glottis exhacerbate a
highly sensitive reflex cough with afferent impulses at the level
of the tracheobronchial tree.
However,none of these mechanisms is perfect and foreign
bodies are frequently lodged in the child’s
airways.
This is an uncommon case in which a heavy foreign body
lodged in to the lower bronchus.different medical options were
considered,first there was the possibility to perform a
toracotomy.secondly if the child would continue asymptomatic,it
was advisable to leave the foreign body in the bronchus due to
the fact that the toracotomy is a quite aggressive and dangerrous
procedure and might be fatal.the treatment set with steroids and
bronchodilators together with the reflex cough , provoked that
the foreign body move up to the laryngeal vestivule and
afterwards it was swallowed,for the luck of the child getting the
normal digestive way to be expelled out in the stools.
The action of steroids and bronchodilator combined with
the reflex cough facilitated the conversion from aspirated
foreign body to ingested foreign body.
REFERENCIAS
1. Holinger LD. Foreign bodies of the larynx, trachea,
and bronchi. In Pediatric otolaryngology. Bluestone CD, Stool SE,
Scheetz MD. 2nd ed. Philadelphia; WB Saunders Co. 1990. Pp.
1205-14.
2. Backofen JE, Rogers MC. Upper airway disease. In
Texbook of pediatric intensive care. Rogers MC. 2nd ed.
Baltimore; Williams & Wilkins, 1992. Pp. 231-57.
3. Tooley WH. Specific diseases causing airway
obstruction. In Rudolph's Pediatrics. Rudolph AM (ed.). 9th ed.
Norwalk; Appleton & Lange, 1991. Pp. 1518-25.
4. Heldlund GL, Kirks DR. Respiratory system. Pp.
515-707. In practical pediatric imaging. Diagnostic radiology of
infants and children. Kirks DR. 2nd ed. Boston; Little Brown
& Co, 1991.
5. Kuhn JP, Slovis TL, Silverman FN, Kuhns LR. Diseases
of the airways and abnormalities of pulmonary aeration. Pp.
465-510. In Caffey's pediatric X-ray diagnosis. Silverman FN,
Kuhn JP. 9th ed. St. Louis; Mosby, 1993.
6. Reilly JS. Airway foreign bodies: uptade and
analysis. Int Anesthesiolo Clin 1992; 30: 49-55.
7. Stool SE, Mannig SC. Foreing bodies of the pharynx
and esophagus. In Pediatric otoryngology. Bluestone CD, Stool SE,
Scheetz MD. 2nd ed. Philadelphia; WB Saunders Co. 1990. Pp.
1009-19.
8. Jiménez CA. Tos crónica en el
niño. En Enfermedad respiratoria en el niño.
Aristizábal G, Reyes MA, Leal FJ. 2ª ed. Cali;
Editorial XYZ, 1991. Pp. 181-96.
9. Orr OL. Protection of the airway against foreign body
aspiration. J Oral Maxillofac Surg 1993; 51: 1161.
10. Davis J, Anaes FC, Alton H, Butler J. Aspiration of
foreign materials and children while under general anesthesia for
dental extractions. Anesth Pain Control Dent
1993; 2: 17-21.
11. Bergerman M, Donald PJ, Wengen DF.
Screwdriveraspiration. A complication of dental implant
placement. Int J Oral Maxillofac Surg 1992; 21:
339-41.
12. Whitley SP, Shaw LH. Dental throat packs and airway
protection. Anesthesia 1992; 41: 173.
13. Roach JM, Ripple G, Dillard TA. Inadvertent loss of
bronchoscopy instruments in the tracheobronchial tree. Chest
1992; 101: 568-69.
14. Moohnssen SR, Greggs D. Iatrogenic aspiration of
components of respiratory care equipment. Chest 1993; 103:
946-65.
15. Botash AS. Syringer capas: an aspiration hazard.
Pedriatrics 1992, 90: 92-3.
16. Prinsley P. Hazards of metered dose inhalers for
asthma. J R Soc Med, 1992, 85:712.
17. Willging JP, Bower CM, Cotton RT. Physical abuse of
children. Arch Otolaryngol Head Neck Surg 1992, 118:
583-90.
18. Taff ML, Boglioli LR. Homicidal traumatic asphyxia
associated with pebble impaction of the upper airway. Am J
Forensic Med Pathol 1992; 13: 271-74.
19. Salzberg AM, Brooks JW, Krummel TM. Oreign bodies in
the air passages. In Disorders of the respiratory tract in
children. Chemick V, Kendig EL. 5th ed. Philadelphia; WB Saunders
Co, 1990. Pp. 476-80.
20. Stern RC. Disease of the respiratory system. Lower
respiratory tract. In Texbook of pediatrics. Behrman RE, Kliegman
RM, Nelson WE, Vaughan VC. 14th ed. Philadelphia, WB Saunders Co,
1992. Pp. 1062-02.
21. Juárez A, Marquet L. Accidentes.
Cuerpos extraños. Quemaduras. En Manual de
pediatría Valenzuela. Valenzuela R, Luenguas J, Marquet L.
11ª ed. México;
Interamericana, McGraw Hill, 1993. Pp. 680-87.
22. Weibley RE. Disorders of the proximal airway. In
texbook of pediatric critical care. Holbrook PR. Philadelphia; WB
Saunders Co. 1993. Pp. 509-16.
23. Guidelines for cardiopulmonary resuscitation and
emergency. Part V. Pediatric basic life support. Committee and
Subcommittee American Heart association. JAMA 1992; 268:
2251-61.
24. Heimlich HJ, Patrick EA. The Heimlich maneuver: best
technique for saving choking victim's life. Postgrad Med 1990;
87: 38-53.
25. Ministerio de Salud. ABC de primeros
auxilios. Cuerpos extraños. Bogotá; Planeta
Editorial Colombia, 1993.
Pp. 117-28.
26. Stephens GR. Asistencia al niño sano. En
Manual de pediatría ambulatoria. Boynton RW, Dunn ES,
Stephens GR. Barcelona; Salvat Editores S.A., 1986. Pp.
1-130.
w
27. Schenden LW, Peacock WF, Tintinalli JE. Aspiration
of radiolucent foreign body. Ann Emerg Med 1992; 210:
771.
28. Snow J B, Ballenger JJ. Otorhinilaryngology head and
neck surgery. 16a Ed. Ontario: BC Decker
Inc;2003:1073-95.
29. Quiroga A,Garcìa S. Broncoscopìa en
pediatrìa. Neumologìa y Cirugìa de Torax.
2006;65(2):136-40.
30. Ospina JC. Cuerpos exraños en vias
aerodigestiva infantil. Acta otorrinolaringológica &
Cabeza y Cuello. 2005:33(2): 36-47.
31. Zúñiga de Velàzquez M.
Anestesia para procedimientos de
ORL en pediatrìa. Rev Venezolana de
Anestesiologìa.2002:7(2):197-201
32. Ruiz LFJ, Valdivia SMM, Latour PJ, et al. Flexible
bronchoscopy with only topical anesthesia. J Bronchol.
2006;13:54-57.
33. Ciftici AO, Binglol-Kologlu M, Senocak ME, Tanyel
FC, Buyukpamukcu N.Bronchoscopy for evaluation of foreign body
aspiration in children. J Pediatric Surg.
2003;38(8):1170-6.
34. Flores SS, Garcìa R, Nuñez C.
Extracciòn de cuerpos extraños de la vía
aérea en niños
mediante broncoscopia flexible. Rev Inst Nal Enf Resp
Mex.2005;18(2):103-108.
35. Emir H, Tekant G, Besik C, Elicevik M, Senyuz OF,
Buyukunal C, Sarimurat N, Yeker D.Bronchoscopic removal of
tracheobroncheal foreign bodies: value of patient history and
timing. Pediatr Surg Int. 2001;17(2-3):85-7.
36. Fraga JC, Neto AM, Seitz E,Schopf L.Bronchostomy and
tracheostomy removal of bronchial foreign body. J Pediatr Surg.
2002;37(8):1239-40.
37. Ramirez JL, Gochicoa LG, Ramirez DH, Vargas MH.
Foreing body removal by flexible fiberoptic bronchoscopy in
ifants and children. Pediatr
Pulmonol.2005;40(5):392-7.
38. Sánchez SP. Hallazgos en la placa de torax en
pacientes con cuerpo
extraño en vias aereas y la relación con
su localización y sintomatología de acuerdo con
el grupo de
edad. (Tesis)
Mexico, DF:UNAM-INER;2003
39. Darrow DH, Holinger LD. Foreing bodies of the
larynx, trachea and bronchi. En Bluestone CD,Stool SE, Alpert CM,
et al. Pediatric Otolaryngology, Vol2. 4a Ed.
Standers;Philadelphia.2003;1543-57.
Anexo – Imágenes
AUTHOR:
– DR. ARMANDO M. LESMO IGLESIAS
ENT ESPECIALIST.
– DR. CARLOS RAMIREZ INFANTE
ENT ESPECIALIST.
– LIC.MARISNEY LOPEZ PEREZ
EMERGENCY NURSE
– DR. ILIANA LEYVA FERNANDEZ
ANESTHESIOLOGY ESPECIALIST.
– DR. DANILO VAZQUEZ BARNES
ENT ESPECIALIST.
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