The festivals of lights which brings the fervour of joy and happiness in our lives turned out to be the most dreadful day for a young couple in Nagpur. On the afternoon of 20th October 2017 what the couple found out was quite unanticipated for them.
A black foreign body was completely obstructing the right main bronchus of the baby
The thirteen month old baby girl was playing with her elder three year old sibling when her mother sighted her gasping for breath. Suspecting that she must had swallowed a fruit’s seed they immediately rushed her to Gastroenterologist to avoid the risk of her life. After realizing that the seed might be obstructing the airways of the patient, The Dr directly referred her to KRIMS Hospitals for intervention. Understanding the overall situation Dr Sameer Arbat on the dot decided to undertake rigid bronchoscopy. But here’s the kicker:
Rigid Bronchoscopy is a highly risky procedure as it was never attempted on such a young patient. But the surprising part was that the chest X-ray was found to be completely normal throwing the doctors in a daze confusing them about the existence of the foreign body inside the patient’s airway. But the labored breathing of the patient along with the stridor told a different story that something was obstructing the airway.
Tracing the foreign body along with the struggle for its removal.
After 15 minutes Dr Sameer and Dr Bharat were able to locate a black foreign body which was completely obstructing the right bronchus while they were performing Rigid Bronchoscopy with a pediatric scope. Now the difficult part was yet to be conducted which was the removal of the seed as the air supply to the right lung was completely compromised leading to decreased oxygen in the patient’s blood. This hypoxia was increasing with every passing minute, making the procedure more difficult and increasing the worries of the team.
Successful removal of the foreign body by the team
A pediatric ventilating-rigid bronchoscope was used to locate the foreign body and remove it with metal forceps. The worst part was removing the seed required multiple attempts as it was slippery and too large to be held by the narrow forceps. The seed was lodged almost 15 cm deep inside the airway and it was around 1.5 cm long and 8mm wide. The size was large enough to completely obstruct the right main bronchus. After 60 minutes of a very difficult procedure the two doctors were able to remove the foreign body, which eventually turned out to be a seed of a custard apple. Paediatrician Dr Pankaj Agrawal who was monitoring the baby’s vitals and Anesthetist Dr Sagar Agrawal who made sure that the baby was properly sedated accompanied the team in the critical procedure.
Later on when Dr Sameer was asked about the case and it’s overall experience he said Since it was a critical emergency me and Dr Bharat decided to approach inside the airway of the baby. But as the anatomy of a 13 month baby is too small and narrow as compared to an adult locating the seed was an intricate task. Recurrent fall in oxygen was an another challenge because of which we had to change our strategy at every step.
The availability of advanced instruments and support from the KRIMS Operation Theatre team made it possible to conduct the operation with success. Prompt alertness by parents also played an important role, as even a delay of few hours in getting the baby to the hospital would have lead to fatality” commented Dr Sameer who is an Interventional Pulmonologist at KRIMS Hospitals Nagpur.