Foreign Body Aspiration in Adult, What Would You Expect? Case Report


Foreign Body Aspiration in Adult, What Would You Expect? Case Report


Zeyad  Faoor  Alrais1,  Mohamed Ibrahim  Shoaib1, Hesham  Mohamed ElKholy1, Asad  Alsabbah2

1Department of Intensive Care Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates. 2Mediclinic City Hospital , Dubai, United Arab Emirates.


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Foreign body (FB) aspiration is an uncommon but potentially life-threatening event, while the majority of accidental aspiration events occur in children, adults represent up to 25% of cases.
When the diagnosis is not established immediately, retained FBs may lead to recurrent pneumonias, bronchiectasis, recurrent hemoptysis, pneumothorax, lung abscesses, pneumo-mediastinum, or other complications. Extraction of aspirated FBs should be undertaken as soon as possible to alleviate acute symptoms and prevent long term complications.
FB aspiration is slightly more common in males. The vast majority of adult patients with FB aspiration have obvious risk factors for aspiration including neurological deficits with swallowing difficulties or altered mental status, neuromuscular disease, intoxication, or have an iatrogenic cause. Still, 10% of adult patients with FB aspiration have no known risk factors.
Our case is 35 y old male patient who was brought to Accident and Emergency department after being found unresponsive in the street, on arrival to hospital his GCS was 9/15 with pin points pupils , spontaneous breathing and hemodynamic stable . CT brain was unremarkable Patient failed to respond to repeated doses of naloxone and his GCS dropped with episode of apnea so was intubated and mechanically ventilated.
Follow up chest x-ray show opacification of the right lung, and ABG reveled hypoxia with respiratory acidosis in spite high ventilator settings, So CT chest was the best option which reveled bronchial obstruction mostly due to foreign body.
Urgent bronchoscopy was done and unexpectedly obstruction was due to chewing gum pieces, aspiration of four large pieces of chewing gum, following that patient remained in the ICU for 2 days where chest x-ray show significant improvement and he was weaned and extubated successfully.


Keywords: Foreign body aspiration, Chewing gum aspiration , bronchoscopy.

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How to cite this article:

Zeyad Faoor Alrais, Mohamed Ibrahim Shoaib, Hesham Mohamed ElKholy, Asad Alsabbah. Foreign Body Aspiration in Adult, What Would You Expect? Case Report. International Journal of Case Reports, 2019 4:101. DOI: 10.28933/ijcr-2019-11-0205


References:

1. J Hewlett, O Rickman, R Lentz, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017 Sep; 9(9): 3398–3409.
2. Sehgal IS, Dhooria S, Ram B, et al. Foreign Body Inhalation in the Adult Population: Experience of 25,998 Bronchoscopies and Systematic Review of the Literature. Respir Care 2015;60:1438-48.
3. Rafanan AL, Mehta AC. Adult airway foreign body removal. What’s new? Clin Chest Med 22(2):319-330, 2001.
4. Mise K, Jurcev Savicevic A, Pavlov N, Jankovic S. Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995-2006. Surg Endosc 2009;23(6):1360-1364.
5. Lin L, Lv L, Wang Y, et al. The clinical features of foreign body aspiration into the lower airway in geriatric patients. Clin Interv Aging 2014;9:1613-8.
6. Blanco Ramos M, Botana-Rial M, García-Fontán E, et al. Update in the extraction of airway foreign bodies in adults. J Thorac Dis 2016;8:3452-6.
7. Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J 2009;102:171-4.
8. Rodrigues AJ, Oliveira EQ, Scordamaglio PR, et al. Flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults. J Bras Pneumol 2012;38:315-20.
9. Dong YC, Zhou GW, Bai C, et al. Removal of tracheobronchial foreign bodies in adults using a flexible bronchoscope: experience with 200 cases in China. Intern Med 2012;51:2515-9.
10. Casalini AG, Majori M, Anghinolfi M, Burlone E, D’Ippolito R, Toschi M, et al. Foreign body aspiration in adults and in children: advantages and consequences of a dedicated protocol in our 30-year experience. J Bronchology Interv Pulmonol 2013;20(4):313–321.
11. Matthew F. Abts, Katherine Hicks, Dana Thompson, Lauren et al. Therapeutic Challenges after Chewing Gum Aspiration in a Toddler: A Case Report .Ann Am Thorac Soc. 2016 Jun;13(6):988-90.