engleski

ASPIRATION OF GRASS BLADE: FROM CHILD’S GAME TO SERIOUS COMPLICATIONS

A ten-year-old boy was playing, holding a grass blade (rye, Secale ceraeale) in his mouth. He choked on and aspirated the grass blade, which induced a spell of coughing and dyspnea. Bronchoscopy had to be interrupted due to severe systemic response considered being an allergic reaction to the anesthetic (Nesdonal). Bronchoscopy was repeated on the next day, however, the grass blade could not be removed and it proceeded to distal airways. Elevated body temperature, chest pain, and coughing accompanied by hypersalivation and difficult breathing persisted in spite of intensive antibiotic and other symptomatic therapy. Then, abundant putrid expectoration occurred. X-ray indicated bronchopneumonia, followed by pleuropneumonia with effusion in the lower half of the right thorax. Migrating distally, grass blade caused a bronchopleural fistula with empyema and partial pneumothorax, and eventually had to be operatively removed (thoracotomy). Development of a pleuropneumocutaneous fistula with spontaneous recovery following grass blade removal through the intercostal space has been described in the literature (one case of timothy grass /Phleum pratense/ and barley /Hordeum murinum/ each). The purpose of this report is to point to the importance of earliest possible removal of a bronchial foreign body and to the severe complications that may develop in case of its unsuccessful removal. Upon entering the tracheobronchial system, a grass blade migrates in a wedge like fashion ; i.e. it moves uncontainably distally, with a tendency of spontaneous elimination via a pneumopleorocutaneous fistula.

aspiration of a foreign body; child; bronchoscopy

nije evidentirano