SESSION TITLE: Procedures Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children with nearly 80% of choking events occurring in those under the age of three. Rigid bronchoscopy is considered the standard of care for evaluation and management of FBA. Chewing gum aspiration (CGA), however, presents a unique dilemma in that fragments of gum may not be easily extracted with traditional approaches. The following case report illustrates the unique clinical challenges that arise in the aftermath of CGA and the utility of ice-cold saline lavage in its removal.
CASE PRESENTATION: A 19 month old previously healthy boy presented to the ED with 4 days of cough and wheezing. Chest radiograph demonstrated right lung hyperinflation, tracheal deviation, and opacification of the left hemi-thorax (image 1). Detailed history suggested the possibility of CGA and the patient was taken to the OR for bronchoscopic intervention. Visualization of the airway revealed diffuse inflammation and multiple fragments of gum throughout the tracheobronchial tree. Large pieces were removed using a rigid-forceps approach (image 2). In the hours following the procedure, the patient was unable to maintain adequate ventilation despite extraordinarily high peak pressures (60-90 mmHg) and was placed on ECMO. Repeat flexible bronchoscopy was successful in removing remaining gum fragments following ice-cold saline lavage. Within an hour, there was remarkable improvement in aeration and pulmonary compliance.
DISCUSSION: This case highlights the life-threatening consequences and therapeutic challenges of CGA. The authors of this case report found that ice-cold saline lavage was instrumental in the removal of small gum fragments that eluded extraction by conventional methods. The removal of gum via freezing has been a staple household anecdote for decades. Gum hardens at lower temperatures, which allows for easier manipulation and removal. Previous case reports have shown that targeted cryotherapy can be used for the removal of aspirated chewing gum1. In our case, probe cryoextraction was not a viable option, as this procedure would almost certainly have damaged surrounding tissue and compromised the patient’s safety.
CONCLUSIONS: This is the first known case report to demonstrate effective removal of chewing gum from the airway with ice-cold saline lavage and suction via flexible bronchoscopy.
Reference #1: Rubio E et al. Cryoextraction: A novel approach to remove aspirated chewing gum. Annals of Thoracic Medicine. 2013;8(1):58-59.
DISCLOSURE: The following authors have nothing to disclose: Matthew Abts, Katherine Hicks, Mary Nevin, Lauren Camarda, Dana Thompson
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