From the Guidelines
Rigid bronchoscopy is not generally indicated for asymptomatic pediatric patients with a history of foreign body ingestion, unless there is suspicion of aspiration or abnormal imaging findings. The initial approach should focus on determining whether the foreign body was truly ingested versus aspirated. For confirmed ingestion (swallowing into the esophagus/gastrointestinal tract), management typically involves radiographic confirmation of the object's location and watchful waiting, as most objects will pass through the digestive system without intervention 1. However, rigid bronchoscopy becomes immediately necessary if there is any suspicion of aspiration (foreign body in the airway), even in seemingly asymptomatic children, as foreign bodies in the tracheobronchial tree can cause serious complications including airway obstruction, pneumonia, or lung abscess.
Some key points to consider in the management of asymptomatic pediatric patients with a history of foreign body ingestion include:
- Determining the likelihood of aspiration versus ingestion
- Performing radiographic confirmation of the object's location
- Watching for signs of aspiration, such as coughing, choking, wheezing, or respiratory distress
- Considering rigid bronchoscopy if there is suspicion of aspiration or abnormal imaging findings 1
- Using flexible bronchoscopy for diagnostic purposes, such as evaluating airway obstruction or obtaining secretions and cells from the lungs
It is essential to note that children may appear asymptomatic despite having a foreign body in their airway, particularly if it has been present for some time and has become lodged in a way that permits adequate air movement. Therefore, a thorough evaluation and consideration of rigid bronchoscopy are crucial in cases with a convincing history of aspiration or abnormal imaging findings.
From the Research
Asymptomatic Pediatric with History of FB Ingestion
Role of Rigid Bronchoscopy
- The role of rigid bronchoscopy in asymptomatic pediatric patients with a history of foreign body (FB) ingestion is limited, as most FBs can be managed with flexible bronchoscopy or endoscopy 2, 3, 4.
- Rigid bronchoscopy is typically reserved for cases where flexible bronchoscopy is not feasible or has failed, or in cases where there is a high risk of complications 2.
- The decision to use rigid bronchoscopy should be based on the patient's condition, the type and location of the FB, and the availability of experienced operators and equipment 5, 3.
- In asymptomatic cases, the management approach may involve observation, endoscopy, or surgery, depending on the location and type of FB, as well as the duration of symptoms 5, 3, 4.
- Flexible bronchoscopy has been shown to be a safe and effective alternative to rigid bronchoscopy for the removal of inhaled FBs in children, with a shorter procedure time and minimal complication rate 2.
Indications for Rigid Bronchoscopy
- Rigid bronchoscopy may be indicated in cases where:
- The FB is large or sharp, and cannot be safely removed with flexible bronchoscopy 3, 4.
- The patient has severe respiratory symptoms or complications, such as bronchospasm or pneumonia 2, 4.
- The FB is lodged in a location that is difficult to access with flexible bronchoscopy, such as the upper airway 2.
- The patient has a history of previous bronchoscopy or surgery, which may increase the risk of complications with flexible bronchoscopy 5, 3.
Considerations for Asymptomatic Patients
- Asymptomatic patients with a history of FB ingestion should be closely monitored for the development of symptoms, and undergo regular follow-up evaluations to assess for the presence of complications 5, 3, 4.
- The decision to perform rigid bronchoscopy or other interventions in asymptomatic patients should be based on the individual patient's risk factors and the potential benefits and risks of the procedure 5, 2, 3.