AUDIT OF SURGICAL TREATMENT OF AERODISGESTIVE TRACT FOREIGN BODY IN LAGOS NIGERIA

FOREIGN BODY IN AEROGISTIVE TRACT

Abstract

Abstract

Background: Foreign bodies in aero digestive tract occur frequently and they are of acute emergency when impacted in the larynx, trachea and of less emergency when impacted in the oesophagus. They may lead to life threatening situation due to respiratory passage obstruction. This study aimed to audit the demography and surgical treatment of foreign body (FB) ingested or inhaled in the aerodigestive tract in patients that present in the emergency room of Lagos State University Teaching Hospital, Ikeja, Lagos State Nigeria.

Methodology: This is a retrospective study of 79 patients with a history of foreign body in the aero digestive tract from January 2014 to December 2019. The data collected include age, gender, type of foreign body ingested or aspirated, also the location of the foreign body from radiological investigations, intervention and anaesthetic technique.   

Results: A total of 79 patients were seen during this period, with a male to female ratio of 2.3: 1. Fifty-two (65.8%) patients were children (3 months to 12 years).  General anaesthesia using intravenous induction was done for patient with oesophageal and hypopharyngeal foreign bodies. Inhalational induction and apnoeic technique was used for patients with impacted foreign body in the larynx.  Most patients 64(71.0%) had impacted foreign body in the oesophagus and hypopharynx and denture was the most common FB and cricopharyngeal sphincter C6 (upper oesophagus) was the most common site of impaction; 15(19%) patients had impacted foreign body in the larynx and bronchus. The most common impacted FB in the laryngotracheobronchial airway was peanut and peanut shell with the most common site of impaction being the larynx.

Conclusion: Video rigid endoscopy with forceps removal under general anaesthesia is the preferred management modality. Removal of foreign body in the larynx will require setting up trays for laryngoscopy, tracheostomy and bronchoscopy before the procedure is started as a suitable algorithm for management of FB in the larynx.  Repeat x-ray is mandatory when patient has already done one 2-3 days prior to presentation at ER.

Keywords: Aerodigestive tract, Bronchoscopy, foreign body, Video oesophagoscopy, video laryngoscopy.