International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Impact Factor (2012): 3.358 Volume 3 Issue 11, November 2014 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Combined use of a Fogarty Balloon Catheter, Bronchoscope, and Tracheostomy for the Controlled Retrieval of an Endobronchial Foreign Body: A Case Report Raman Wadhera 1 , Sharad Hernot 2 , Sat Paul Gulati 3 , Vijay Kalra 4 , Madhuri Kaintura 5 , Aditi Singla 6 1 MS, Professor, Department of Otorhinolaryngology, PT. BDS PGIMS Rohtak-124001, Haryana, India. 2 MS, Senior Resident, Department of Otorhinolaryngology, PT. BDS PGIMS Rohtak-124001, Haryana, India. 3 MS, Senior Professor & Head, Department of Otorhinolaryngology, PT. BDS PGIMS Rohtak-124001, Haryana, India. 4 MS, Assistant Professor, Department of Otorhinolaryngology, PT. BDS PGIMS Rohtak-124001, Haryana, India. 5, 6 MS, Junior Resident, Department of Otorhinolaryngology, PT. BDS PGIMS Rohtak-124001, Haryana, India Abstract: The inhalation of foreign body into the tracheobronchial tree presents a life-threatening situation. A satisfactory outcome requires the timely and atraumatic removal of the offending agent. The morbidity associated with present methods of dealing with this problem is well documented. A case is illustrated describing the efficacy and simplicity of technique of endoscopic extraction with the aid of a fogarty embolectomy catheter and tracheostomy. Keywords: Foreign body; bronchoscopy; tracheostomy; and fogarty catheter 1. Introduction The inhalation of foreign body into the tracheobronchial tree presents a life-threatening situation. 1 Foreign body aspiration is classically a paediatric problem with the highest incidence occurring in children younger than 5 years. Bronchial foreign body can occur in adults as well, albeit often with less acute symptoms. The classical signs of acute choking, wheezing, loss of unilateral breath sounds with corresponding volume loss, or hyperinflation due to air- trapping on the radiographs have a sensitivity of 70%. Other findings such as chronic cough, recurrent pneumonia in the same chest region, atelectasis, pneumothorax, or pneumomediastinum, are more common in adults. Rigid bronchoscopy has been the standard procedure for removal of airway foreign bodies, and remain so in the pediatric population. However, there should always be a backup plan for rigid bronchoscopy should the aspirated foreign body prove too stubborn for removal by rigid bronchoscopes. 2 We present a case report of a 9 year old girl who aspirated a gemstone of approximate size 1.5x1.5 cm, that got lodged at carina, which was unsuccessfully attempted to be removed by rigid bronchoscopy and grasping forceps, and finally it was removed with the help of a fogarty catheter. 2. Case Report A 9 year old girl was brought to our institute with history of aspiration of a gemstone 1 day prior. Patients had two episodes of vomiting and cough since then, and on presentation, she was having mild difficulty in breathing. Patient was immediately investigated for X-ray chest, along with routine investigations. X-ray chest showed a round radiopaque shadow at the level of carina (Fig 1). Patient was taken up for rigid bronchoscopic foreign body removal under general anesthesia. Foreign body was visualized in trachea at the level of carina, and was attempted to be removed by grasping forceps. Multiple attempts were made, but because of its smooth surface and large size, foreign body could not be successfully grasped by the forceps. Opinion of cardiothoracic surgeon was taken who advised for thoracotomy. Despite that, trial with fogarty catheter was decided by us. Trachesostomy was done. Bronchoscope was again introduced through mouth and foreign body was visualized impacted at carina. Through the bronchoscope, fogarty catheter was passed beyond the foreign body, bulb was inflated, and catheter was gently and gradually withdrawn, disimpacting the foreign body, and slowly negotiating it proximally towards the tracheostomy stoma. The foreign body was visualized at tracheostomy stoma, from where it was grasped by allis forceps and removed (Fig 2). Patient in the postoperative period had stable vitals and maintained oxygen saturation at 95-100% at room air. Trachesotomy stoma was closed on post operative day 5. 3. Discussion The inhalation of foreign bodies into the tracheobronchial tree in small children is frequently an emergency situation. 1,3 Accidental aspiration of foreign body into the tracheobronchial tree in both adults and children can result in significant morbidity and mortality. 4,5 Management of airway foreign bodies consists of clinical examination, appropriate tests to diagnose the presence of an airway foreign body, and quick removal of FB from airway. 6,7 Paper ID: OCT14451 338