Journal of Clinical Research & Case Reports Citation: Mallick AA, Naeem M, Nasir M, Mirza S, Aziz S. Delayed Diagnosis of Foreign Bodies in Esophagus and in Bronchus in Eight Month Duration Admitted in Paediatric Intensive Care Unit (PICU) of a Tertiary Care Centre. J Clin Res Case Rep 2017; 1:102. Global Scientifc Library Delayed Diagnosis of Foreign Bodies in Esophagus and in Bronchus in Eight Month Duration Admitted in Paediatric Intensive Care Unit (PICU) of a Tertiary Care Centre Ashfar Alam Mallick 1 , Mehwish Naeem 1 , Maimoona Nasir 1 , Sadiq Mirza 2 and Sina Aziz 3 * 1 Paediatric resident, Karachi 2 Associate professor, Abbasi Shaheed Hospital, Karachi 3 Head of department P.I.C.U Abbasi Shaheed Hospital, Karachi Case Report *Corresponding author: Sina Aziz, Head of department P.I.C.U Abbasi Shaheed Hospital, Karachi, Email: sigma_98@hotmail.com Received: June 05 2017; Accepted: July 10 2017; Published: July 12 2017 Ingested foreign bodies range from children putting whatever they want in their mouth. Coins account for 70% of paediatric ingested foreign bodies; coins will typically become ‘stuck’ at the level of the cricopharyngeus muscle [2]. Sharp ingested foreign bodies can be potentially problematic when lodged in the oesophagus patients will ofen require emergency endoscopy, more ofen than not if the sharp object is within reach of endoscopy it will be removed before it progress further [3]. An important thing to consider when assessing coin like objects is button batteries, it may look like coins and can be potentially fatal when in contact with surrounding tissues they can generate an electric current that will break down fuid turning it hydroxide leading to severe, potentially fatal mucosal damage [4,5]. Metal, glass and stone can be visualised very well using conventional plain flm radiography, yet more organic structures such as wood may require further imaging such as ultrasonography [6,7]. Commonly, aspirated foreign bodies will have a clear clinical correspondence: choking, coughing, neck pain or struggling to breathe. Te right main bronchus is the most common site of obstruction due to the anatomy of the bronchial tree favouring the right side (larger diameter, more vertical orientation). Ofen two orthogonal plain radiographs are the primary investigation of choice [7]. Te investigations of foreign bodies rely heavily on radiology, yet every foreign body will have an optimal modality for investigation. Te radiological appearance in plain radiography of foreign bodies is dependent on two factors: the x-ray attenuation of the foreign object, the surrounding structures and any overlying structures that may veil the object. Te anatomical location will not only afect the radiopacity of the suspected foreign body, but the rate of magnifcation as the object is placed further or closer to the detector, lateral cervical radiographs can have a magnifcation rate of up to 21.6% [8]. In children depending upon the anatomical location of the foreign body symptoms can vary. Commonly in our local scenario it can be mistaken for pneumonia and treated as such, till symptoms do not improve and paediatrician then thinks of foreign body which leads to the actual diagnosis. Foreign body inhalation is common in our part of the world. However, recently in our unit, an upsurge was seen, where in a time period of 6months, fve foreign body inhalation cases were seen, of which three same aetiology (beetle nuts). Beetle nut is very common addiction of adult men and women in metropolitan city of Karachi, Pakistan. Children not supervised may take these beetle nuts copying parents, resulting foreign body inhalation. A delayed diagnosis in foreign body cases can be detrimental for the child. Hence, early diagnosis and management is essential. Tis centre does not do Keywords: Foreign body; Children; Respiratory distress; Paediatric; ICU Abstract We present fve cases of foreign body inhalation in eight month period (May -Dec 2016) admitted in P.I.C.U of Abbasi Shaheed Hospital. Age range was eleven months to four years. Male gender was predominant among the case series. All of the cases presented with sudden onset of respiratory distress along with fever and cough. On examination all patients were febrile, tachypneic, tachycardia with subcostal and intercostal recessions. A working diagnosis of severe pneumonia was made and children were put on intravenous antibiotics and nebulization, two children were on Continuous Positive Pressure Ventilation (CPAP) and one was on ventilator support. Within 48 hours of admission, there was no improvement clinically so suspicion of foreign body was made on the basis of clinical ground. Rigid bronchoscopy was done; foreign body in 1 patient chicken bone and in 4 patient’s betel nut was found. All children showed rapid improvement afer removal of foreign body and were discharged soon afer. Parents were counselled regarding addiction of betel nut and avoidance of foreign body inhalation in growing children. In patient with foreign body in oesophagus the symptoms were more acute. Foreign body inhalation should be kept as a diferential diagnosis in every child presenting with sudden onset of respiratory distress without improvement despite treatment. Parents should also be counselled for being vigilant around their children. Introduction Foreign bodies are any object that originates outside of the human body. More ofen than not, foreign bodies will occur involuntarily as a result of an accident such as motor vehicle collisions, stepping on broken glass, gunshot wounds, or explosions. On occasions, foreign bodies can be voluntary, ofen inserted into natural and unnatural cavities [1], more so by children, who may not be adequately supervised by parents or other adults. Te most retrieved foreign body in our study was betel nut (46%), which was found by an earlier study to be 65.6%. Peanut was the most retrieved (45%) foreign body in one series, while another one found it to be 55%. Similarly, melon seed was the most retrieved (70%) foreign body in one series. Fisfs seed (33%); fsh bone, 15%; and beans, 24%.