Pune: A four-year-old boy was admitted to a city-based hospital for choking recently as it swallowed an unknown foreign body while playing and had difficulty in breathing. By the time he reached the hospital, he had a cardiac arrest. 

Doctors from Jehangir Hospital said it was obvious that something was stuck in the windpipe of the child. As an emergency measure, a tube was inserted into its main wind pipe so as to push the foreign body on one side. The intention was to enable, at least one lung to start functioning and save the child. He required resuscitation, including cardiac compression and injecting adrenaline, after which he recovered. Soon, he regained consciousness.

Dr Dasmit Singh from the hospital said the child needed a diagnostic bronchoscopy.

“Bronchoscopy confirmed the presence of a very hard foreign body on one side, which had caused severe inflammation and swelling of the lining of the bronchus. The foreign body was jammed and could not be dislodged. A decision was taken to do a special type of CT scan with virtual bronchoscopy to understand the nature of the matter better,” said Dr Singh.

He added that relatives recalled that the child ate some kind of dried fruit available in the north-east.

“That was when the child got a sudden coughing episode. For further investigation and treatment, the child was then shifted to the hospital. A virtual bronchoscopy revealed a foreign body - a seed stuck in the right lower bronchus causing complete obstruction of that portion of the lung.

This needed to be removed. The plan discussed with the parents was to try bronchoscopy again, but if the foreign body did not get dislodged, we might be forced to do a major operation, thoracotomy, by opening the bronchus and removing the seed. This was a potentially life-threatening operation, but in that situation, there would be no choice but to take the risk and go ahead. Leaving the foreign body was not an option because that in itself would prove fatal,” said Dr Singh.

When the child was to be shifted for surgery, he went into continuous fits.
“His oxygen in the body dropped significantly and he desaturated. His heart slowed down and he went into cardiac arrest. The paediatric emergency team immediately swung into action and Cardio-Pulmonary Resuscitation was initiated. He was immediately intubated, after which he could be revived. He was then shifted to the Pediatric Intensive Care Unit (PICU) and put on a ventilator, along with medicines to support the pumping of the heart. He was resuscitated and stabilised by the PICU team,” said Dr Singh.

The foreign body had not budged from its position, but even then the child got a cardiac arrest. So the cause was different. The child was taken in the operation theatre for removal of the foreign body.
Dr Singh then performed the bronchoscopy, but it was impossible to dislodge the foreign body.

“The next option was resorted to and the chest was opened for thoracotomy. An opening was made in the bronchus. At this time, it became very difficult to ventilate the baby because most of the anaesthesia gases and oxygen would leak out from the opening. So speed was of the essence. Finally, the foreign body was successfully grasped and removed. It was so swollen up that even removing with open surgery was quite difficult,” he said.

Dr Singh added that the procedure met with success and the patient was shifted back to the PICU on the ventilator.

“In due course of time, he was weaned off the ventilator onto spontaneous breathing. His oxygenation remained stable and the child improved. He was shifted out to ward and subsequently discharged. It is not often that a patient can be brought back from almost a fatal position on two occasions and who lives to tell the tale,” said Dr Singh.

Precautions to be taken
Pediatric Surgeon Dr Dasmit Singh said, “No child under the age of three years should be given small things, as they can get aspirated into the windpipe. Also, one should ensure no child should be jumping and eating at the same time. If any child gets a sudden bout of cough while eating, the possibility of a foreign body aspiration must be kept in mind. The child rushed to a hospital with adequate facilities of a fully-equipped Pediatric  Intensive Care Unit (PICU) and pediatric  surgical facilities.”