Foreign Bodies

Foreign BodiesInhalation of a foreign body represents one of the commonest and most dangerous of thoracic surgical emergencies. Especially in children it is frequently fatal. Any child with the history of possible recent foreign body inhalation should have a rigid bronchoscopy performed as an emergency. This operation should be performed by an experienced endoscopist and anaesthetist as it has significant morbidity and mortality in inexperienced hands. The presenting x-ray may be completely normal or show lung collapse or hyper-expansion. Every year we resect lung destroyed by a chronically retained foreign body, most commonly plastic pieces from ball point pens.

Oesophageal foreign bodies are generally easier to manage endoscopically, and rarely get missed as the patients have ongoing dysphagia. Occasionally oesophageal foreign bodies, especially coins may migrate through the wall of the oesophagus requiring surgical removal. They may erode into surrounding vascular structures.

Other intra-thoracic foreign bodies frequently encountered are broken off knife blades, scalpel blades sometimes lost during insertion of chest drains when proper scalpel handles are not used and other traumatic injuries such as gunshot or piercing injuries from wooden poles and metal rods. These should be removed either at formal thoracotomy or via thoracoscopy.