Extraction Of Soft Friable Foreign Bodies From The Tracheobronchial Tree

Categories: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The difficulties here consist in the liability of crushing or

fragmenting the object, and scattering portions into minute bronchi,

as well as the problem of disimpaction from a ring of annular edema,

with little or no forceps space. There is usually in these cases an

abundance of purulent secretion which further hinders the work. The

great danger of pushing the foreign body downward so that the swollen

mucosa hides it ompletely from view, must always be kept in mind.

Extremely delicate forceps with rather broad blades are required for

this work. The fenestrated peanut forceps are best for large pieces

in the large bronchi. The operator should develop his tactile sense

with forceps by repeated practice in order to acquire the skill to

grasp peanut kernels sufficiently firmly to hold them during

withdrawal, yet not so firmly as to crush them. Nipping off an edge by

not inserting the forceps far enough is also to be avoided. Small

fragments under 2 mm. in diameter may be expelled with the secretions

and fragments may be found on the sponges and in the secretions

aspirated or removed by sponge pumping. It is, however, never

justifiable deliberately to break a friable foreign body with the hope

that the fragments will be expelled, for these may be aspirated into

small bronchi, and cause multiple abscesses. A hook may be found

useful in dealing with round, friable, foreign bodies; and in some

cases the mechanical spoon or safety-pin closer may be used to

advantage. The foreign body is then brought close to, but not crushed

against the tube mouth.



[174] Removal of animal objects from the tracheobronchial tree is

readily accomplished with the side-curved forceps. Leeches are not

uncommon intruders in European countries. Small insects are usually

coughed out. Worms and larvae may be found. Cocaine or salt solution

will cause a leech to loosen its hold.



Foreign bodies in the upper-lobe bronchi are fortunately not common.

If the object is not too far out to the periphery it may be grasped by

the upper-lobe-bronchus forceps (Fig. 90), guided by the collaboration

of the fluoroscopist. These forceps are made so as to reach high into

the ascending branches of the upper-lobe bronchus. Full-curved

coil-spring hooks will reach high, but must be used with the utmost

caution, and the method of their disengagement must be practiced

beforehand.