Aspiration of a needle and retrieval via bronchotomy in a 2-year-old child: a case report

Abstract

Introduction

Foreign body aspiration in children is uncommon, with an incidence of 1 case per 10,000 children per year. Most cases occur in children younger than three years. The retrieval of aspirated foreign bodies can be challenging.

Case presentation

A 2-year-old boy was referred to our pediatric surgery department because of a suspected needle ingestion or aspiration two months before. He had a recent history of intermittent vomiting, fever, and cough. His physical exam was within normal limits. A chest X-ray revealed a metallic object resembling a 2.9-cm needle in the left paravertebral region at the level of the 6th to 8th thoracic vertebrae. With the initial thought that the needle could be in the esophagus, he underwent initially an endoscopy, but no foreign body was found in the esophagus. Bronchoscopy was not available at the time of the endoscopy. We then proceeded with a thoracic computerized tomography (CT) scan, which confirmed that the needle was lodged in the left lower bronchus. He was taken to the operating room for an attempted bronchoscopic retrieval, but it was not successful. We decided to remove the foreign body surgically through a left thoracotomy. The needle was identified by palpation. A transverse incision was made on the left lower bronchus, and the needle was successfully retrieved. The bronchus was closed with interrupted stitches of 5.0 monofilament sutures. A chest tube was left in place. His recovery was uneventful. The chest tube was removed three days after the operation, and he was discharged home seven days after the operation.

Conclusions

Patients with suspected ingestion foreign body and inconclusive plain films must undergo advanced imaging studies to rule out a location outside the gastrointestinal tract before undergoing any endoscopic or surgical interventions. Surgery continues to play a role in the management of aspirated foreign bodies in selected cases.