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correspondence

Indian Pediatr 2015;52: 534-535

Spontaneous Migration of Airway Foreign Body to the Gastrointestinal Tract


*Jayalaxmi S Aihole and M Narendra Babu

Department of Pediatric Surgery, IGICH Bangalore,  Karnataka, India.
Email: [email protected]

 


 


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.

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).

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.

 

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