http://www.saudija.org/article.asp?issn=1658-354X;year=2019;volume=13;issue=1;spage=89;epage=90;aulast=Mohanty;type=3
Foreign bodies are common among the pediatric population. Plain radiograph AP view is the standard to diagnose and localize ingested or aspirated foreign body (FB). Most of the patients need either sedation or general anesthesia for FB removal depending on its position. Point-of-care ultrasound (POCUS) of the upper airway can be used for detection and also as a dynamic tool for monitoring the changes in the position of the FB during the attempt of its removal. It has been used for the localization and removal of soft tissue FB.[1] Here, we present a case of use of POCUS for upper esophageal FB removal.
A 3-year-old male child, 11 kg, presented to the emergency department with a history of ingestion of FB. The plan was to remove it under general anesthesia. Chest X-ray AP view confirmed a radio-opaque FB. He was premedicated with injection glycopyorrolate 0.1 μg, fentanyl 2 μg/kg, and inj. midazolam 0.5 mg iv. Ventilation was assisted with 50% oxygen and sevoflurane. Inj attracurium 0.5 mg/kg was administered, and trachea was intubated with cuffed size 4 endotracheal tube. The SonoSite M-Turbo ultrasound machine with linear 13--6 MHz transducer was used to confirm the location of FB [Figure 1]. It was removed with the help of esophagoscope. Initially, it was visible but was lost during manipulation. There was a doubt of the passage of FB down in the esophagus, but the ultrasound was suggesting its presence in the upper esophagus. Esophagoscope was repositioned and the FB was removed in the fourth attempt with minimal trauma. It is not rare to detect the FB in preprocedure X-ray, but finding nothing during exploration under anesthesia.
We suggest the use of POCUS before or after anesthesia, depending on the co-operation of the patient posted for FB removal. It will also avoid unnecessary radiation exposure in the pediatric population.[2] Further studies are needed to consider it as a part of FB management algorithm.
A 3-year-old male child, 11 kg, presented to the emergency department with a history of ingestion of FB. The plan was to remove it under general anesthesia. Chest X-ray AP view confirmed a radio-opaque FB. He was premedicated with injection glycopyorrolate 0.1 μg, fentanyl 2 μg/kg, and inj. midazolam 0.5 mg iv. Ventilation was assisted with 50% oxygen and sevoflurane. Inj attracurium 0.5 mg/kg was administered, and trachea was intubated with cuffed size 4 endotracheal tube. The SonoSite M-Turbo ultrasound machine with linear 13--6 MHz transducer was used to confirm the location of FB [Figure 1]. It was removed with the help of esophagoscope. Initially, it was visible but was lost during manipulation. There was a doubt of the passage of FB down in the esophagus, but the ultrasound was suggesting its presence in the upper esophagus. Esophagoscope was repositioned and the FB was removed in the fourth attempt with minimal trauma. It is not rare to detect the FB in preprocedure X-ray, but finding nothing during exploration under anesthesia.
 | Figure 1: Radio-opaque foreign body (yellow arrow) inside esophagus (ESO); CCA: Common carotid artery; IJA: Internal jugular vein Click here to view |
We suggest the use of POCUS before or after anesthesia, depending on the co-operation of the patient posted for FB removal. It will also avoid unnecessary radiation exposure in the pediatric population.[2] Further studies are needed to consider it as a part of FB management algorithm.
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