Difficult airway foreign body removal

Foreign body (FB) aspiration in children is a common emergency. Traditionally, rigid bronchoscopy has been considered to be the mainstay for removal. However, in certain cases, flexible bronchoscopy can prove to be a better option and avoid thoracic surgery and unnecessary morbidity. Here, we describe the case of a child with accidental aspiration of a 4 cm long sewing needle, lodged in the lateral basal segment of the left lower lobe. Rigid bronchoscopy was unsuccessful as it could not access the distally placed needle. Instead, a flexible bronchoscopy performed through the endotracheal tube after sedating and paralysing the patient was effective and the needle could be grasped and removed using a wire basket. We describe our patient management protocol for paediatric airway FBs, which has been quite effective and prevents procedural delay. Expertise of the operator and a concerted team effort are the recipe for success.