Tracheobronchial Foreign Body Extraction in a Preterm Infant via Choledochoscope: A Case Report and Literature Review.

Objectives: Tracheobronchial foreign body (TFB) extraction in premature neonates poses unique challenges due to their delicate respiratory system, making the TBF extraction a critical and high-stakes intervention. TFBs in this patient population are mostly iatrogenic. There are only a few reports in the literature describing the management of TFBs in premature neonates. To the best of our knowledge, this represents the first report using a flexible choledochoscope for TFB extraction.

Methods: A retrospective chart review was conducted on a case of a preterm infant who underwent successful extraction of a tracheobronchial foreign body.

Results: A premature neonate born at 25 weeks 2/7 days gestation with a birth weight of 780 g was intubated after delivery. Following extubation to non-invasive ventilation, a control chest radiograph revealed atelectasis of the right lower lobe and a TFB of tubular structure measuring 20 mm × 1.5 mm in the right main bronchus. Diagnostic flexible bronchoscopy was performed and extraction with graspers via rigid bronchoscope was attempted but failed. Subsequently, a bedside procedure in the Neonatal intensive care unit (NICU) was performed using a 7.5 Fr flexible choledochoscope through the endotracheal tube (ETT). TFB was successfully extracted with graspers and upon extraction, it was confirmed to be the distal 2 cm segment of the closed-circuit endotracheal suction system. The infant made full recovery.

Conclusion: We report a method that provides a safe means of TFB extraction with a successful outcome. The insights gathered from this review are intended to contribute valuable knowledge that can enhance the management of TFBs in preterm infants.