Aspirative foreign body converted in ingested foreign body (página 2)

Enviado por Dr. Armando M. Lesmo Iglesias

Partes: 1, 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.

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.

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