FOREIGN BODIES IN TIIE TRACHEA AND IN THE BRONCHI Foreign bodies not infrequently- find their way into the trachea and into the bronchi in children while eating (coarse bread crumbs, small pieces of bone), or while playing (buttons, nails, pebbles, beans, corn, etc.), being aspirated while laughing or coughing. Frequently the for eign body lodges in the larynx and produces symptoms similar to croup. It may still after some time get into the trachea. Smooth, rounded objects often immediately glide into the trachea after an attack of suf focation, where they at once lodge or remain mobile according to their size and shape, or if of smaller circumference may slip into a bronchus.
If the foreign body which gains access to the trachea is large, rapid suffocation may result. Quite frequently, it remains movable and is then sometimes moved up and down with an audible clapping or flutter ing noise, or it may- be felt' by the finger placed on the trachea. It pro duces a painful cough by which it is thrown against the glottis which closes spasmodically from its impact, bringing about at times a severe attack of suffocation. By a fortunate accident, occasionally-, the for eign body may soon or perhaps, only after some time, be coughed out. If the foreign body becomes lodged anywhere it causes little incon venience except local pain and symptoms of stenosis often without any particular symptoms of irritation.
Periods of rest and attacks of suffocation (in transitory- mobiliza tion) may alternate. Auscultation will yield, according to circumstances, either a negative finding, a flapping sound between the shoulder blades, or sy-mptoms of stenosis of the trachea; while from injury or ulceration of the mucous membrane there is often a bloody or sanguinopurulent expectoration. Smaller objects sooner or later get into a main bronchus, and in the majority of cases (over two-thirds) into the right bronchus. When the main bronchus becomes entirely or to the greater part occluded characteristic signs are produced. In athlition to the dyspncea, which at first threatens, the respiratory movements, the respiratory murmur, and the fremitus, are diminished or abolished in the affected side. The percussion note is normal, except that there is lacking a displacement of the lower borders of the lungs. If a bronchus is only partly occluded, a loud whistling sound is heard over the corresponding side of the thorax.
In complete occlusion of a large bronchus the isolated portion of the lung rapidly becomes atelectatic. Moreover, symptoms of bron
chitis and bronchopneumonia with fever set in usually after a few days; and in the same manner also in occlusion of a smaller bronchus. Subse quently, abscesses, bronchiectasis, pleurisy, pyopneumothorax, and more rarely gangrene of the lungs, frequently develop. The sound side shows compensating emphysema.
The diagnosis of the foreign body is usually easy if the history plainly points to it; otherwise, in the ease of a tightly wedged body, it is often very difficult, unless one's attention is called to it by an initial suffocative attack or the appearance of acute symptoms of stenosis and bloody sputum. Circumscribed bronchopneumonia in robust children especially in the right lower lobe, which without further cause occurs acutely, must lead one to suspect a foreign body, especially if this bron chopneumonia, or bronchiectasis, recurs frequently in the same spot. The rupture of a caseous bronchial gland into a main bronchus often produces symptoms similar to a foreign body. The diagnosis is fre quently rendered easy by an X-ray examination. Where nothing is known regarding the aspiration of a foreign body, or where the symp toms only appear after some time, the diagnosis is often never made and the patients die of pseudophthisis, bronchopneumonia, etc.
The prognosis is always very grave, as fatal suffocation arid dan gerous complications may set in at any time. The prognosis in cases of aspirated corn is very bad.
attempt may be made to expel the foreign body by vomiting and retching; in cases of smooth heavy objects, suspension by the legs and slapping the back may also occasionally accomplish the purpose. But these procedures are not entirely free from danger. The most certain remedy is always tracheotomy as soon as the diagnosis is established. It is also to be recommended when the foreign body is freely movable in the wind-pipe and causes no serious disturbance, since one is never safe from sudden suffocation and incurable pulmonary changes. Tracheotomy is advantageously preceded by a preventive in tubation. The foreign body is often coughed out spontaneously on open ing the trachea, though frequently it must be removed with a suitable instrument, or wire snare. For this purpose Killian's bronchoscopy may give valuable service. After the successful removal of the foreign body. the tracheotomy wound is immediately closed. Foreign bodies in the second division of the bronchi cannot usually be reached by tracheotomy.