Impacted Laryngeal Foreign Body in a Child: A Diagnostic and Therapeutic Challenge
A 4-year-old boy was brought to otolaryngology emergency of our hospital to rule out suspected foreign body, a plastic pen anterior detachable segment, in his aero-digestive tract. The history was given only by the child himself to the parents that a kid had forced him to swallow a pen cap in his play school, 4 days back. The surprising part was that apart from history of occasional respiratory wheeze on exertion and while swallowing, the child was totally comfortable and had no cough, change in voice, or respiratory distress. Respiratory system examination at rest was normal. An high resolution computed tomographic scan of neck with chest was advised and revealed a conical foreign body with a lumen just below the level of vocal cords [Figures -].\nThe patient was taken for urgent bronchoscopy. Injection glycopyrrolate, midazolam, and pentazocine were given as premedication. In addition, he received intravenous anesthesia (propofol and sevoflurane) with scoline as muscle relaxant. Intermittent apnea technique was employed, in which foreign body removal was attempted with a pediatric bronchoscope (Karl Storz ventilating rigid bronchoscope; size 4 mm) in the apnea period of 2-3 minutes duration. As soon as patient came on spontaneous ventilation or saturation fell down, again injection scoline and atropine were given, and manual controlled ventilation was given with 100% oxygen. A blue-colored conical foreign body was removed with forceps by trailing method in head low position with slight difficulty as it was impacted below the cords at the laryngotracheal junction []. The foreign body was a 1.2 cm long hollow proximal part of a plastic pen and was slightly flattened. Child was immediately extubated and kept in pediatric intensive care unit for 48 hours with injectable steroids for 3 days.\nBefore coming to our hospital, due to the lack of obvious symptoms, absent chest findings, and normal chest x-ray, the foreign body was missed.