A five-year-old girl was recently admitted to Lilavati Hospital at Bandra Reclamation after being transferred from another hospital with a case history of having accidentally inhaled a foreign body.
An attempt was made to remove the object ‘endoscopically’ as it was presumed to be in the food pipe but later, once confirmed to be in the left lower lobe of left lung Bronchus , Bronchoscopy was done.
This procedure failed and child developed cardiac arrest during the procedure, she revived with cardiopulmonary resuscitation and four DC shocks to the heart.
In addition there was lot of bleeding in the lungs, so the child was put on a ventilator and subsequently transferred to Lilavati Hospital for an emergency surgery.
An urgent CT scan chest was done to delineate the exact location of the object which the father confirmed was a LED bulb with two sharp metallic prongs (which was used for lighting during Diwali.)
This was placed inverted in the bronchus , hence the difficulty in removal by bronchoscopy. CT also confirmed the prongs were dangerously close to large arteries in chest and the heart so an emergency retrieval was planned.
A team of doctors headed by Lt Gen (Dr) V Ravishankar, Consultant Cardiothoracic surgeon and Dr Rajiv Redkar, Consultant Paediatric surgeon performed the operation along with Anaesthetists Dr Namrata Kothari and Dr Madhuri Kharwadkar. Post-operative care in paediatric ICU was by Dr Minaz Sheikh.
The child’s chest was opened by left thoracotomy and after locating the sharp object in left lower lobe of the bronchus (lung). A Bronchotomy was done to open the bronchus and it was removed after carefully removing the metallic prongs which were embedded in the wall, the incision on bronchus was closed with sutures.
Anaesthesia was challenging since single lung anaesthesia is difficult in children. The child made an safe and stable recovery and was discharged on the fourth day.
Children in the age group 3 to 6 years have a tendency to put small objects in their mouth like peanuts, small toys, safety pins, some metallic parts etc,.
This is the first time we have seen a LED bulb with two sharp metallic leads being accidentally inhaled and could not be removed by bronchoscopy, being malpositioned.
Almost all foreign objects in the respiratory passage can be usually removed by Bronchoscopy, surgery is rarely required in just 0.5 to 4 % cases, however we did not attempt bronchoscopy again as there was already an episode of bleeding and cardiac arrest in the first attempt.