Flexible Bronchoscopic Removal of Foreign Bodies from Pediatric Airways

The rigid bronchoscope has been the instrument of choice for removal of tracheobronchial foreign bodies in pediatric patients. Application of the flexible bronchoscope for this purpose is somewhat controversial. We report our experience with six pediatric patients with tracheobronchial foreign bodies, in all of whom foreign bodies were successfully removed using a small-caliber flexible bronchoscope and an ultrathin flexible bronchoscope supplemented with forceps and baskets normally employed for the extraction of ureteral stones. In one child, a straight pin had lodged in the periphery of the right middle lobe. Flexible bronchoscopy and ureteral stone forceps were used under fluoroscopic guidance to extract the straight pin. We believe that this approach alleviated the need for thoracotomy and should be considered in the removal of any small foreign object in the distal bronchial tree. There were no complications associated with any of the procedures. In selected patients, flexible bronchoscopic removal of even large foreign bodies is feasible provided that the bronchoscopist is prepared to manage potential complications associated with the procedure and successfully employ the rigid bronchoscope if the flexible bronchoscopic technique fails.