Tracheobronchial foreign bodies are common in
pediatric population, especially in the first six years of life. Most
inhaled foreign bodies are found in the right main bronchus [1].
Spontaneous expectoration of sharp metallic foreign bodies is rare. All
airway foreign bodies require prompt retrieval by bronchoscopy to
prevent complications [2,3].
A 2-year-old boy presented to us with history of
cough, fever and loss of appetite for 15 days. He had mild respiratory
distress; trachea was central and air entry was reduced on right side
with presence of occasional crepitations. Chest X-ray showed
right-sided sharp metallic screw-like foreign body along the course of
right main bronchus, with its tip pointing medially and upwards, along
with consolidation of lower lobe (Fig. 1A). He was taken
up for rigid bronchoscopy after 2 hours of admission, but there was no
foreign body in tracheobronchial tree; the right main bronchus had
tell-tale signs of inflammation. Intra-operative radio-imaging with
C-Arm revealed migration of foreign body into the stomach (Fig.
1B). This was managed expectantly with serial radiological
imaging which revealed progressive passage of the foreign body along the
gastrointestinal tract (Fig. 1C and 1D). Later,
patient passed the foreign body in stools.
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Fig. 1 Metallic foreign body in the
right main bronchus (A); in the stomach (B); in the distal small
bowel (C); and in the cecum (D).
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Spontaneous expulsion of intra-bronchial foreign
bodies has been reported in adults [3,4] and children [1,5,6]. However,
spontaneous migration of tracheobronchial foreign body into
gastrointestinal tract is extremely rare. In our case, patient must have
expectorated the foreign body, and immediately swallowed it. Awareness
about this situation is helpful when one does not find an expected
airway foreign body during bronchoscopy. Intra-operative imaging will
help in the diagnosis and guiding further management.
References
1. Kaur K, Sonkhya N, Bapna AS. Foreign bodies in the
tracheobronchial tree: A prospective study of fifty cases. Indian J
Otolaryngol Head Neck Surg. 2002;54:30-4.
2. Jackson, C. Prognosis of foreign body in the lung.
JAMA. 1921;77:1178-82.
3. Hadi MA, Al-Telmesani LM. Spontaneous expulsion of
intrabronchial metallic foreign body: A case report. J Family Community
Med. 1997;4:77-9.
4. Mital OP, Prasad R, Singhal SK, Malik A, Singh PN.
Spontaneous expulsion of a long standing endobronchial metallic foreign
body. Indian J Chest Dis Allied Sci. 1979;21:45-7.
5. Jaiswal AA, Garg AK. Spontaneous expulsion of
foreign body (sewing machine needle) from right middle lobe bronchus – A
rare case report. J Clin Diagn Res. 2014;8:KD01-2.
6. Gupta SK, Mundra RK, Goyal A. Spontaneous expulsion
of an interesting long standing metallic foreign body (iron nail) from
left main bronchus. Indian J Otolaryngol Head Neck Surg. 2004;56:233-4.