Vol 5 No 3 October 2020

E-ISSN: 2528-410X

CASE REPORT

Management of Foreign Body of Peanuts in the Trachea in Children

Jerry Tobing

Faculty of Medicine, University of Methodist Indonesia

Correspondence Email: jerryfjtobingtobing@yahoo.co.id

Abstract: Foreign body is an object that enters an organ that comes from outside the body or
from inside the body that does not normally exist. One of the objects in the respiratory tract can
occur in the trachea and occur in many children. Case report: a girl, 1 year 11 months of age with
complaints of shortness of breath since 1 day before, had tachypnea, indirect laryngoscopy:
multiple secretions, difficulty speaking vocal cords, inspiratory-expiratory stridor (+),
suprasternal, epigastric and intercostal ( +). Bronchoscopy: white round foreign body
(impression: peanut) covering> 50% of the tracheal lumen over the carina, mucosal edema, and
hyperemia. A bronchoscopy was administered as a diagnostic and therapeutic role.

Keywords: foreign body aspiration, trachea, bronchoscopy

INTRODUCTION Aspiration of a foreign body in the

Foreign objects in an organ are airway can occur in all, but most commonly
objects that come from outside the body or occurs in childhood. This is because
from inside the body, which under normal children often put objects in their mouths to
circumstances do not exist. Foreign objects find out their shape and taste, and to chew
that come from outside the body are called while teething. The most common cause is
exogenous foreign bodies, usually entering the carelessness of patients and parents who
through the nose or mouth. Exogenous do not monitor children's activities.3,4,5
foreign bodies consist of organic substances Aspiration of foreign bodies can
such as legumes (which come from plants), cause a variety of complaints from minimal
bones (those from animal skeletons), and symptoms or even not felt, to airway
inorganic substances such as nails, needles, disorders that can cause death.
pins, stones, and others. Foreign objects When a foreign object enters, a
that come from within the body, are called spasm can occur accompanied by cyanosis
endogenous foreign bodies. Endogenous and a cough reflex which is a protective
foreign bodies can be in the form of thick reflex. However, after the foreign object is
secretions, blood or blood clots, pus, crusts, stuck and the protective reflex is exhausted,
tumors, diphtheria membranes, symptoms disappear and a latency period
bronchiolitis, amniotic fluid, meconium occurs.2
which can enter the baby's airway during In the case of aspiration of a foreign
childbirth..1,2 body, a diagnosis should be made based on
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a good history, correct physical Pulse rate: 96 x / minute, regular

examination, and other supporting Respiratory rate: 28 x / minute, regular
examinations so that there is no delay in Temperature: 36,80C
handling which can make the patient feel
suffocated or short of breath.3 Localized status
If there is a clinical suspicion of Ears: normal
aspiration of a foreign body, an endoscopy Nose: normal, breathing nostrils (-)
must be performed immediately to prove Oropharynx: normal
the presence or absence of a foreign body. Indirect laryngoscopy: lots of secretions,
The treatment of choice for removal of difficult to assess vocal cords
foreign bodies is endoscopically as soon as Stridor inspirational-expiratory (+), audible
possible under the safest conditions and slap (-), palpatory thud (-)
minimal trauma. Bronchoscopy should be Suprasternal, epigastric, and intercostal (+)
performed at a fast and appropriate time to retraction, crackles (-)
reduce the risk of complications, but should
not be done in a hurry without careful Laboratories exam
preparation. 1,5,6
A bronchoscopy is an option for the Hb : 11,5 g/dL (11-16,5 g/dL)
extraction of aspirated foreign bodies in the Leukocytes: 13,7 x 103 /mm3(3,5-10/mm3)
case of children due to safer ventilation, Hematocrit : 33,3 % (35-50%)
which has direct contact with oxygen so pH : 7,389 (7,35-7,45)
that it is easier to perform and quicker to do pCO2 : 31,1 mmHg (38-42 mmHg)
if there is bleeding..5,7 pO2 : 165,5 mmHg (85-100 mmHg)
HCO3¯: 18,4 (22-26)
This case report reports a case of a peanut Total CO2 : 19,3 (19-25)
foreign body stuck in the trachea in a girl Base exces: - 6,6 (-2±2)
aged 1 year 11 months. Sa O2: 99,1 (95 – 100)
Pediatrician Consultation: There were no
other abnormalities in the children's section
CASE REPORT
Chest X-Ray result:
A girl aged 1 year 11 months was
brought to the hospital emergency room Cor/Pulmo within normal limits, no radio-
with complaints of shortness of breath that opaque foreign body visible.
the patient had experienced since 1 day ago.
The patient chokes while eating peanuts. At
that time, the patient looked tight, then
coughed violently and partially vomited the
peanuts. When he was admitted to the
hospital, the patient still had a cough and
his voice was weakened, but there was no
fever and his lips did not turn blue.
Vital sign:
Consciousness: Compos Mentis
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Differential diagnose: until the vocal cords are visible, the

1. Airway obstruction e.c. suspected bronchoscope is rotated 90 to the right.
tracheobronchial corpus alienum  After passing through the vocal cords,
2. Upper respiratory tract infection the laryngoscope is removed and the
Main diagnosis: bronchoscope is rotated again 90 ° to
Airway obstruction e.c. suspected the left to the starting position.
tracheobronchial corpus alienum  The bronchoscope is pushed slowly
down the trachea, a white round foreign
Therapy: body appears (impression: peanut)
- O2 1-2 L/minutes covering> 50% of the tracheal lumen
- IVFD D5%-NaCl 0,4 % 20 drop /minutes over the carina, mucosal edema, and
- Inj. Cefotaxime 250 mg/8 hours i.v. hyperemia.
- Inj. Dexamethasone 2,5 mg/8 hours i.v.
- Inj. Metamizole Na 150 mg/8 hours i.v
Recommendation: Bronchoscopy
Anesthesiologist consultation: Agree to
bronchoscopy under general anesthesia

Operation report:

 The patient put to sleep on the operating

table under general anesthesia, the
infusion is attached.  The foreign body is held with a suitable
 With the aid of a laryngoscope, no cunam and removed with the
rigid bronchoscope. 4 is inserted bronchoscope.
perpendicularly along the tongue to  The foreign object was ruptured after
reveal the uvula. passing through the vocal cords, then
removed with the help of a
laryngoscope, showing 6 pieces of
peanut fragments.

 At the base of the tongue, the

bronchoscope is lowered with a gentle
push until the epiglottis appears, neck
extended. •Re-evaluated with a bronchoscope, it
 After showing the epiglottis, the shows the tracheal lumen, the right and
bronchoscope is entered underneath it left main bronchi are clear.

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•The general condition post of the most common entry of foreign

bronchoscopy is good, there is no objects in the nose, because this part is an
bleeding organ that is very easy to reach children..8
Of all cases of foreign bodies that
Diagnose: Corpus alienum of peanuts in the enter the respiratory tract and digestive tract
trachea (post bronchoscopy) that occur in children, one-third are the
result of foreign objects aspirated and stuck
Therapy : in the respiratory tract. Of the cases of
foreign bodies stuck in the respiratory tract,
- O2 1-2 L/minute
55% occurred in children aged 4 years with
- IVFD D5%-NaCl 0,45% 20 drops/minutes
a higher incidence of sudden death due to
- Inj. Cefotaxime 250 mg/8 hours i.v.
aspiration of foreign bodies. Meanwhile, in
- Inj. Dexamethasone 2,5 mg/8 hours i.v. (1
infants under 1 year of age, respiratory
day)
distress due to aspiration of foreign bodies
- Inj. Metamizole Na 150 mg/8 hours i.v
in the airway is the main cause of death.9
Foreign objects in the nose often
Follow-up :
occur in children due to curiosity so that
Post bronchoscopy day II:
children try and explore all parts of their
 Complaints: fever, shortness of breath,
body, especially the holes in their body
and hoarseness (-) normal
parts by inserting small objects into the
eating and drinking
holes. Then children tend to put foreign
 Consciousness: Compos mentis objects in their mouths while playing,
 Pulse rate : 104 x/minute crying, or laughing. This situation can cause
 Respiratory rate : 24 x/minute, crackles choking and even death. Commonly
(-) encountered foreign objects such as nuts,
 Temperature : 36,80C seeds, batteries, beads, and sponges. 10
Therapy: Foreign bodies on the children often
- IVFD D5%-NaCl 0,45% 20 drops /minute go unnoticed by parents because of no
- Inj. Cefotaxime 250 mg/8 hours i.v symptoms and poor coping skills. Therefore
- Inj. Dexamethasone stopped it is necessary to do a fairly careful patient
history. In several studies conducted, the
Post bronchoscopy day III presentation of patients presenting to the
 Complaints : (–) emergency department more than 48 hours
 Consciousness: Compos mentis after inserting a foreign object into the nose
 Pulse rate : 100 x/minute, accounted for 14% of all cases with the
 Respiratory rate : 24 x/minute, crackles most frequent symptoms of nasal
(-) congestion and shortness of breath. The
 Temperature : 36,50C diagnosis is confirmed by taking anamnesis,
Therapy : Cefadroxil 3 x 125 mg/day physical examination and carrying out
• Patients can go home and outpatient supporting examinations such as
DISCUSSION radiological examinations and endoscopic
Foreign objects are the most examinations to see the location of the
common cases in children and the location foreign object.. 11

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In the above case, based on the history, the away from small objects that are accessible
patient was 1 year 11 months old and to children and can be dangerous.
experienced symptoms of shortness of Periodic follow-up is necessary to
breath and was taken to the hospital where assess further complications from
he was subjected to a careful physical bronchoscopy such as bleeding, lacerations
examination and it could be suspected that of the nasal septum, mucosal ulceration,
there was a foreign object in the patient's and necrosis..12 After the examination and
airway although the exact location of the there are no symptoms after the procedure,
object was not yet known. Then performed the patient is allowed to go home and the
a chest X-ray examination and continued patient is recommended to go to the
with bronchoscopy which acts as both polyclinic 5 days later.
diagnostic and therapeutic.
The foreign object has been in the patient's CONCLUSION
airway for 1 day and causes mucosal edema A foreign body in the nose is a
and the patient experiences shortness of clinical problem that has its own challenges
breath and coughing. This is because the because its management is a procedure that
foreign object is an organic substance that requires the skill and experience of the
is irritative. Organic foreign bodies are doctor performing the procedure. The
absorbent and then expand and over time presence of a deep foreign object in the
will cause rapid swelling, causing a severe nose is most often found in children (ages
inflammatory reaction within a few 2-5 years). 11
hours.11,12
Therefore, foreign objects in the To diagnose a foreign body in the
nose must be removed immediately to nose, anamnesis, physical examination,
prevent complications. Foreign objects can examination of local tourism status, and
be removed depending on the size, shape, appropriate investigations are performed.
and texture of the foreign object. Other The initial therapy for foreign bodies in the
factors that support each other are the nose is the extraction of these foreign
support from cooperative patients, the bodies by one of the methods used is
availability of tools to be used, and the bronchoscopy and administration of
skills of the associated doctors.10 antibiotics, analgesics, and corticosteroids
In the case above, bronchoscopy is to avoid complications caused by the
administered because the foreign object in extraction..12
the nose is already causing symptoms of
shortness of breath and action must be
REFERENCES
taken immediately. Furthermore,
1. Ballenger JJ. Bronkologi. Dalam:
pharmacological therapy is given to avoid
Penyakit telinga hidung tenggorok
complications from the action.
kepala dan leher. Jilid 1, Edisi 17,
It is necessary to provide education
Jakarta: Bina Rupa Aksara; 2010. p.
to the community to reduce the incidence of
619-43.
foreign matter aspiration into the airways,
2. Dhingra PL. Foreign bodies of air
especially for mothers who have babies or
passages. In: Diseases of ear nose and
children aged less than 3 years to keep

Buletin Farmatera 252

Fakultas Kedokteran (FK)
Universitas Muhammadiyah Sumatera Utara (UMSU)
http://jurnal.umsu.ac.id/index.php/buletin_farmatera
Vol 5 No 3 October 2020

E-ISSN: 2528-410X

throat. 6th ed. New Delhi: Elsevier; and therapeutic measure. Postgrad Med
2013. p. 296–90. J 2000;76:484-7.
3. Kashikar S. Impacted Laryngeal 12. Davies PH, Benger Jr. Foreign bodies
foreign body in a child: a diagnostic in the nose and ear: a review of
and therapeutic challenge. 2013. Doi: technique for removal in the
10.4103/2141-9248.117937. p. 464-6. emergency department. J Accid Emerg
4. Siegel LG. Penyakit jalan nafas Med 2000; 17: 91-4.
bagian bawah, esofagus dan
mediastinum. Dalam: Boeis Buku ajar
penyakit THT. Edisi ke-6, Jakarta:
Balai Penerbit Kedokteran EGC; 2012.
p. 455-72.
5. Junizaf MH. Benda asing di saluran
napas. Dalam : Buku ajar ilmu
kesehatan THT-kepala leher, edisi ke-
7. Jakarta: Balai Penerbit FKUI; 2014.
6. Warren KY, Ellen MF. Ingestion injury
and foreign bodies in the aerodigestive
tract. In: Bailey’s head and neck
surgery, otolaryngology. Baltimore:
M.D. Lippincott Williams and Wilkins;
2014.
7. Fitri F, Prijadi J. Bronkoskopi dan
ekstraksi jarum pentul pada anak.
Jurnal Kesehatan Andalas. 2014; 3
(3):538-44.
8. Alberto C, Francesca F, Desiderio P,
Luisa B. Nasal foreign bodies; the
experience of the buenosaires pediatric
otolaryngology clinic. Pediatr Intr J.
2011; 53(1):90-3.
9. Mariana HJ. Benda asing di saluran
nafas. Dalam: Soepard AE, Iskandar N,
Bashiruddin J, restuti DR, editor. Buku
ajar ilmu kesehatan telinga hidung
tenggorok kepala dan leher. Jakarta:
Balai Penerbit FKUI; 2007. p. 259-65.
10. Fischer JI, Dronen SC. Nasal Foreign
body. Medscape. 2015.
11. Kalan A, Tariq M. Foreign bodies in
the nasal cavities a comprehensive
review of etiology, diagnostic pointers,

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