Choice Of Time To Do Bronchoscopy For Foreign Body

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The difficulties of removal usually increase from the time of aspiration

of the object. It tends to work downward and outward, while the mucosa

becomes edematous, partly closing over the foreign body, and even

completely obliterating the lumen of smaller bronchi. Later,

granulation tissue and the formation of stricture further hide the

object. The patient's health deteriorates with the onset of pulmonary

pathology, and renders him a less favorable subject for bronchoscopy.

Organic foreign bodies, which produce early and intense inflammatory

reaction and are liable to swell, call for prompt bronchoscopy. When a

bronchus is completely obstructed by the bulk of the foreign body

itself immediate removal is urgently demanded to prevent serious lung

changes, resulting from atelectasis and want of drainage. In short,

removal of the foreign body should be accomplished as soon as possible

after its entrance. This, however, does not justify hasty,

ill-planned, and poorly equipped bronchoscopy, which in most cases is

doomed to failure in removal of the object. The bronchoscopist should

not permit himself to be stampeded into a bronchoscopy late at night,

when he is fatigued after a hard day's work.

Bronchoscopic finding of a foreign body is not especially difficult

if the aspiration has been recent. If secondary processes have

developed, or the object be small and in a bronchus too small to admit

the tube-mouth, considerable experience may be necessary to discover

it. There is usually inflammatory reaction around the orifice of the

invaded bronchus, which in a measure serves to localize the intruder.

We must not forget, however, that objects may have moved to another

location, and also that the irritation may have been the result of

previous efforts at removal. Care must be exercised not to mistake the

sharp, shining, interbronchial spurs for bright thin objects like new

pins just aspirated; after a few days pins become blackened. If these

spurs be torn pneumothorax may ensue. If a number of small bronchi are

to be searched, the bronchoscope must be brought into the line of the

axis of the bronchus to be examined, and any intervening tissue gently

pushed aside with the lip of the bronchoscope. Blind probing for

exploration is very dangerous unless carefully done. The straight

forceps, introduced closed, form the best probe and are ready for

grasping if the object is felt. Once the bronchoscope has been

introduced, it should not be withdrawn until the procedure is

completed. The light carrier alone may be removed from its canal if

the illumination be faulty.