Foreign bodies of the trachea and bronchi: causes, symptoms, diagnosis, treatment

Penetration of a foreign body into the lower respiratory tract is a fairly common occurrence; for this to happen, the foreign body must "deceive the vigilance" of the laryngeal locking mechanism and "catch by surprise" the wide-open entrance to the larynx during a deep breath preceding laughter, sneezing, or a sudden cry. Foreign bodies of the respiratory tract are as varied and similar in origin as foreign bodies of the esophagus, and can be inorganic or organic - from nails, needles, and fruit seeds to living organisms (leeches, worms, flies, wasps, etc.). The frequency ratio of foreign bodies of the respiratory tract to foreign bodies of the esophagus is 1:(3-4).

In children aged 2 to 15 years, the frequency of foreign bodies in the respiratory tract is more than 80% of all foreign bodies. Most often, these are small, varied objects that children play with, put in their mouths and at the same time laugh or cry, scream or yawn deeply. In adults, fragments of dentures, fallen out crowns of teeth, small objects used in various professions (nails, hairpins) are most often observed.

According to various authors, the frequency of penetration into various parts of the respiratory tract is as follows: foreign bodies of the larynx - 12%, foreign bodies of the trachea - 18%, foreign bodies of the bronchi - 70%. Foreign bodies of the trachea are mostly mobile, the so-called balloting foreign bodies. Foreign bodies of the bronchi, if their size is smaller than the lumen of the bronchus, can migrate from bronchus to bronchus. If a foreign body wedges into the main bronchus, it causes irritation of the mucous membrane and respiratory failure. Such foreign bodies cause inflammatory changes in the mucous membrane and the wall of the bronchus - from catarrhal inflammation and edema to ulceration and perforation of the bronchial wall, leading to mediastinal emphysema.

The most aggressive in terms of the disorders and dysfunctions they cause are organic foreign bodies, which, when in the bronchus for a long time, decompose, swell (for example, beans, peas) and clog its lumen, pushing the walls apart and disrupting their integrity.

Secondary complications in the form of suppuration, atelectasis, pneumothorax spread to the lung tissue and pleura, causing purulent pleurisy, lung abscesses, bronchiectasis. Organic bodies, in addition to local complications, when decaying and releasing toxic substances, can cause toxic damage to the body, which can lead to the death of the victim within 2-4 days. Of great importance in the pathogenesis of the disorders caused by foreign bodies in the trachea and bronchi are pathological reflexes such as viscerovisceral bronchobronchial, which contribute to generalized bronchospasm, secondary trophic disorders and a decrease in the body's resistance.

Symptoms and clinical course of foreign bodies in the trachea and bronchi. The penetration of a foreign body into the respiratory tract is accompanied by a very dramatic picture (the debut phase): the victim, in the midst of complete health, and sometimes in the midst of a cheerful feast, suddenly experiences suffocation, causing him a terrible feeling of death, he begins to rush about, looking for a way to escape, rushes to the tap, to the window, to the people around him for help. Such a picture is more characteristic of sudden complete obstruction of the larynx or trachea with complete blockage of the respiratory tract. Usually, if it is not possible to remove this foreign body in some way, and this is most often the case, the patient very quickly loses consciousness and dies from paralysis of the respiratory center and cardiac arrest. If the tracheal obstruction is incomplete or the foreign body has penetrated into one of the main bronchi and further, then the second phase begins - the phase of relative compensation of the respiratory function, corresponding to the fixation of the foreign body at a certain level.

Balloting foreign bodies are most often observed in the trachea and most often in small children who, during play, aspirate beads, beans or other small objects that are freely placed in the lumen of the trachea. This may remain unnoticed by adults and manifests itself only when a foreign body is suddenly pinched in the subglottic space: the child "turns blue", loses consciousness, falls and remains motionless for some time (several tens of seconds). At this time, relaxation of the spasmodic muscles occurs, the foreign body is released and falls back into the lumen of the trachea, consciousness and normal breathing return, and the child continues the interrupted game. Such attacks in small children are often mistaken for "falling sickness" by uninformed parents, while others - for an attack of epilepsy or spasmophilia. However, the true cause remains unrecognized until the child is taken to the doctor. And here, even with a thorough physical examination, it is not always possible to establish the true cause of these attacks. Auscultation, during which a characteristic noise produced by the movements of a foreign body during forced breathing is heard over the sternum, or tracheoscopy, during which this foreign body is removed, can help with diagnosis. Careful questioning of eyewitnesses of the attack can help with diagnosis or at least suggest the presence of a balloting foreign body; they can notice that such attacks occur precisely when the child lies on his back, stands on his head, or somersaults, in a word, during active play.

Wedged (fixed) foreign bodies are most often observed in the bronchi, and their presence there is tolerated by the victim quite easily. Pathological signs occur only with secondary infection of the bronchus and the occurrence of chest pain, cough, mucopurulent sputum, often with an admixture of blood, i.e. when the third, late stage of foreign bodies of the lower respiratory tract occurs. For this stage, the characteristic signs are a strong cough, abundant mucopurulent sputum, an increase in body temperature, dyspnea, inflammatory changes in the blood. These signs indicate the occurrence of secondary inflammation of the tissues surrounding the foreign bodies. They are edematous, infiltrated, foreign bodies are surrounded by growths of granulation tissue. These phenomena often complicate endoscopic diagnostics of a foreign body, and in the presence of low-contrast bodies - and X-ray diagnostics.

Complications of foreign bodies in the bronchi can be early and late. Early complications include simple bronchitis and lung abscess, while late complications include chronic bronchorrhea and, in particularly advanced cases, bronchiectasis.

Diagnostics is not difficult with foreign bodies in the trachea. It is more difficult with foreign bodies in the main bronchi. As the caliber of the lungs decreases, recognizing foreign bodies becomes more difficult. The main diagnostic tools are tracheobronchoscopy and radiography.

Treatment of foreign bodies in the bronchi involves removing the foreign bodies, but as noted above, this is not always successful the first time or even at all. The latter applies to small foreign bodies of organic origin stuck in a small bronchus. Most often, such a foreign body disintegrates, liquefies and self-liquidates, with the inflammatory complications described above possible. Usually, attempts to remove a foreign body from the trachea and bronchi are made using tracheobronchoscopy, but in certain cases, removal through a lower tracheostomy is indicated. This method is recommended for use in children under 3 years of age. The time for removing a foreign body is determined by the severity of the clinical course. In the absence of severe respiratory distress, when the circumstances and condition of the patient allow for some delay, removal of the foreign body can be postponed for 24-48 hours, especially if the patient is tired or some correction of the general condition, cardiac activity and other medical assistance is required.

After removal of foreign bodies, some patients require rehabilitation measures, and after removal of complicated foreign bodies, they also require prophylactic use of antimicrobial agents.

The prognosis largely depends on the patient's age. It is most serious for infants and children in the first years of life, as well as for the elderly.

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