A peanut, stuck in the respiratory tract of a 14-month-old child from Navi Mumbai was successfully removed by a team of pediatric doctors of Apollo Hospitals Navi Mumbai after 30 minutes of rigid bronchoscopy. The child was in an unconscious state when she was shifted to Apollo Hospitals with SPO2 of 70-75% on 100 Oxygen on high flow nasal cannula. She was immediately intubated and ventilated at the ER of Apollo Hospitals Navi Mumbai, and an emergency bronchoscopy saved her life.
The patient had been admitted to multiple health facilities in the vicinity with respiratory distress and wheezing, she was being treated as HRAD & LRTI. She had also screened positive for COVID 19. However, as distress worsened & severe hypoxia started, she was immediately rushed into the ER of Apollo Hospitals with complaints of chronic symptoms of wheezing and distress, Type 1 respiratory failure, and she was in cold shock too. The child was immediately intubated & ventilated. She also required fluid boluses F/B inotropic infusions for her hemodynamic stabilization. She was treated with nebulisation, steroids & antibiotics up-gradation.
On further detailed examination, doctors observed that she had difficulty in breathing, low oxygen levels and poor air movement in her lungs. She was unable to maintain the oxygen saturation of 90% even on high PEEP. Her Chest X-Ray was also not showing lung involvement typical of severe hypoxia. Considering the severe hypoxia, and ongoing symptoms of almost 3 weeks the possibility of a foreign body was considered. A CT chest was done which confirmed a foreign body blocking the left main bronchus, immediately the team of doctors took high-risk consent from her parents for undergoing the rigid bronchoscopy procedure, and finally, the entire peanut was removed from the left lung bronchus. However, despite all these procedures, her left lung had still completely collapsed due to the presence of a foreign body obstructing her for such a long duration. Post-procedure the child required PEEP titration, Chest physiotherapy, Mucolytic nebulization and steroids and was successfully extubated after 5 days of bronchoscopy.
The patient was kept in a post-operative ward when she reported improvement in her breathing. Now the child is breathing normally with both her lungs and doing well without any difficulty or need for external oxygen. The patient was admitted to the Paediatric Intensive Care Unit (PICU) under the supervision of Dr. Abhijit Bagde (Consultant, Pediatrics), Dr. Hemant Lahoti (Consultant, Pediatric Surgeon), Dr. Vandana Jawalkar (Anesthesiologist), Dr. Rahul Verma (PICU), Dr. Narjohan Meshram (PICU).
Dr. Abhijit Bagde, Consultant Pediatrics said: “Sometimes children, especially under five years of age, swallow or inhale object like peanuts, small plastic or metallic parts of toys, or any other small object. These foreign bodies can also congest the windpipe or trachea blocking the airway passage. This was a critical case, could have been fatal, we performed the procedure just in the nick of time.”
Dr. Hemant Lahoti, Consultant, Pediatric Surgeon, who performed the life-saving procedure said: “Foreign bodies are a common problem in children. We must have a high index of suspicion to avoid delay in diagnosis as it could be fatal. Rigid ventilating bronchoscopy is the life-saving procedure with excellent results in expert hands. Best results are possible only in a tertiary care centre with multidisciplinary team of experts.”
Speaking about the case the team of doctors said: “In this particular case, the child had gone to multiple hospitals but the problem went undiagnosed. Thus doing a rigid bronchoscopy in a severely hypoxic child is very difficult and can be life-threatening. However, considering the clinical condition, that was the only therapeutic option. Hence procedure was done after taking HIGH-RISK CONSENT”.
Mr. Santosh Marathe, Regional CEO said: “This was a classic case of using the Bronchoscopy technique effectively on a 14-month-old child. Early recognition and suspicion of a foreign body aspiration are essential to avoid ineffective medical therapy and repeat admissions. Apollo Hospitals offers 20+ subspecialities under Institute of Child Health, backed by a very experienced PICU team. The prompt management and coordinated efforts made by experts including the surgical team, nursing staff, anesthetists, and pediatrics have managed the child safely and effectively”.
For more information visit: https://www.apollohospitals.com/