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

Penetration of the foreign body into the lower respiratory tract is a rather frequent phenomenon, for this it is necessary that this foreign body "deceive the vigilance" of the laryngeal locking mechanism and "take unawares" a wide open entrance to the larynx during a deep inspiration preceding laughter, sneezing, sudden screaming. The foreign body of the respiratory tract is as diverse and similar in origin as the foreign body of the esophagus, and can be inorganic and organic - from nails, needles and seeds of fruits to living organisms (leeches, worms, flies, wasps, etc.). In frequency, the ratio of foreign bodies of the respiratory tract to foreign bodies of the esophagus is 1: (3-4).

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

According to different 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, so-called balloting foreign bodies. Foreign bodies of bronchi, if their size is less than the lumen of the bronchus, can migrate from the bronchus to the bronchus. If the foreign body is wedged into the main bronchus, it causes irritation of the mucous membrane and impaired breathing. Such foreign bodies cause inflammatory changes in the mucous membrane and bronchial walls - from catarrhal inflammation and edema to ulceration and perforation of the bronchus wall leading to emphysema of the mediastinum.

The most aggressive with respect to the caused disorders and function disorders are organic foreign bodies that, for a long time in the bronchial cavity, decompose, swell (for example, beans, beans, peas) and block its lumen, pushing the walls apart and breaking their integrity.

Secondary complications in the form of suppuration, atelectasis, pneumothorax extend to the lung tissue and pleura, causing purulent pleurisy, lung abscesses, bronchiectasis. Organic bodies, in addition to local complications, during the decay and release of poisonous substances can cause toxemic injuries of the body, which can lead the victim to death within 2-4 days. Important pathogenesis of caused disorders in foreign bodies of the trachea and bronchi is pathological reflexes such as viscerovisceral bronchial bronchial, which contribute to generalized bronchospasm, secondary trophic disorders and reduced resistance of the organism.

Symptoms and clinical course of foreign bodies of the trachea and bronchi. Penetration of the foreign body in the respiratory tract is accompanied by a very dramatic picture (the debut phase): the victim, in the midst of complete health and sometimes in a cheerful feast, has a sudden gasp, causing him a terrible feeling of death, he starts to rush about, seek a way to salvation, rushes to Crane, to the window, to the people around him for help. This pattern is more typical for sudden complete obstruction of the larynx or trachea with complete overlapping of the airway. Usually, if it is not possible in some way to remove this foreign body, and more often than not, the patient very quickly loses consciousness and dies from paralysis of the respiratory center and cardiac arrest. If the obstruction of the trachea is incomplete or the foreign body penetrated into one of the main bronchi and further, then the second phase - the phase of relative compensation of the respiratory function, corresponding to fixation of the foreign body at a certain level, begins.

Balloting foreign bodies are most often observed in the trachea and most often in young children, who during the game aspirate beads, legumes or other small objects freely located in the lumen of the trachea. This can go unnoticed by adults and manifests itself only when the foreign body suddenly collapses in the underlay space: the child "turns blue", loses consciousness, falls down and remains motionless for a few tens of seconds. At this time, the relaxation of spasmodic muscles begins, the foreign body is released and again falls into the lumen of the trachea, consciousness and normal breathing return, and the child continues the interrupted game. Such attacks in young children are often unenlightened parents are taken for "falling", others - as an attack of epilepsy or spasmophilia. However, the true cause remains unrecognized until this child is brought to the doctor. And even here with a careful physical examination, it is not always possible to establish the true cause of these seizures. Diagnosis can be assisted by auscultation, in which a characteristic noise produced by the movements of a foreign body during forced breathing or a tracheoscopy at which this foreign body is removed is heard above the breastbone. To help diagnose or at least assume the presence of a balloting foreign body, a thorough questioning of eye-witnesses of the attack can be observed, which may be noticed that such attacks occur precisely when the child lies backwards, stands on the head or somersaults, in a word, during a mobile game.

The wedged (immobile) foreign bodies are most often observed in the bronchi, and their presence there is easily transferred to the affected. Pathological signs occur only with secondary infection of the bronchus and the occurrence of pain in the chest, cough, mucopurulent sputum, often with an admixture of blood, ie, when the third, late stage of foreign bodies of the lower respiratory tract comes. For this stage, characteristic signs are a strong cough, profuse mucopurulent sputum, an increase in body temperature, dyspnea, inflammatory changes in blood. These signs indicate the occurrence of a secondary inflammation of the surrounding foreign bodies of tissues. They are edematic, infiltrated, foreign bodies are surrounded by proliferation of granulation tissue. These phenomena often complicate the endoscopic diagnosis of a foreign body, and in the presence of low-contrast bodies - and X-ray diagnostics.

Complications of foreign bodies of bronchi can be early and late. To the early cases are simple bronchitis and abscess of the lung, to the late - chronic bronchorea and in especially neglected cases - bronchiectasis.

Diagnosis does not cause difficulties with foreign bodies of the trachea. It is more difficult for foreign bodies of the main bronchi. As the caliber of the lungs decreases, the recognition of foreign bodies becomes more complicated. The main diagnostic tools are tracheobronchoscopy and radiography.

Treatment of foreign bodies of bronchi is to remove foreign bodies, however, as already noted above, it does not always succeed from the first time and does not always succeed at all. The latter refers to small foreign bodies of organic origin, stuck in the shallow bronchus. Most often, such a foreign body disintegrates, dilutes and self-destructs, and the above-described complications of an inflammatory nature are possible. Usually, attempts to remove the foreign body of the trachea and bronchi are carried out by tracheobronchoscopy, but in certain cases removal through the lower tracheostomy is indicated. This method is recommended for children under 3 years. The time of removal of a foreign body is determined by the severity of the clinical course. In the absence of a marked violation of breathing, when the circumstances and the patient's condition allow for some delay, removal of the foreign body can be delayed for 24-48 hours, especially if the patient is tired or some correction of the general condition, cardiac activity and other medical benefits is required.

After the removal of foreign bodies, some patients need rehabilitation measures, and after the removal of complicated foreign bodies - and in the preventive use of antimicrobial agents.

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

[1], [2], [3], [4], [5], [6], [7]