On dört yaþýndaki epilepsi hastasýnda büyük bir tahta kaþýk parçasýnýn iyatrojenik aspirasyonu

Yabancý cisim aspirasyonu çocukluk döneminde yaygýn ve hayatý tehdit eden acil bir durumdur. Mental retardasyon öyküsü olan, 14 yaþýnda erkek hasta, yabancý cisim aspirasyonu tanýsýyla baþka bir merkezden hastanemize nakledildi. Öyküsünden birkaç yýldýr epilepsisi olduðu öðrenildi. Yaklaþýk 10 saat önce, evde, jeneralize tonik-klonik kasýlmalar sýrasýnda, olasý bir havayolu yaralanmasýný önlemek amacýyla ailesi aðzýna acilen tahta kaþýk yerleþtirmiþ. Ancak hasta diþleriyle kaþýðýn sapýný kýrarak, aniden büyük bir tahta parçasýný aspire etmiþti. Rijit bronkoskopla yapýlan deðerlendirme, glottisin 2 cm ilerisinde, dikey olarak yerleþmiþ, büyük bir tahta parçasýnýn varlýðýný gösterdi. Bu büyük tahta kaþýk parçasýnýn trakeadan bronkoskopla çýkarýlmasý uzun ve zor olsa da baþarýlý oldu. Ancak bu giriþimi takiben, yoðun bakým ünitesinde hastada subkutan amfizem ve pnömotoraks olduðu görüldü. Yoðun bakým ünitesinde yerleþtirilen toraks tüpü ile genel durumu düzelen hasta, rijit bronkoskopiden üç gün sonra taburcu edildi. Erken taný ve yabancý cismin acilen çýkarýlmasý mortaliteyi önemli ölçüde azaltmaktadýr. Ancak yabancý cisme veya bronkoskopiye ait komplikasyonlar geliþebilir. Sonuç olarak, yabancý cismin fiziksel özellikleri, pozisyonu ve yerleþim yeri, tecrübeli ellerde bile, sonucu etkileyebilir.

Iatrogenic aspiration of a large piece of a wooden spoon in a 14-year-old epilepsy patient

Foreign body aspiration in childhood is a common and life-threatening emergency. A 14-year-old male with history of mental retardation was transferred from another center to our hospital with diagnosis of foreign body aspiration. According to the anamnesis, he had been diagnosed with epilepsy a few years ago. Approximately 10 hours before admission, while at home, his parents had urgently placed a wooden spoon in the boy’s mouth during a generalized tonic-clonic seizure to avoid possible airway injury. Nevertheless, he had inhaled a large piece of the wood after breaking the handle of the spoon with his teeth. Rigid bronchoscopic evaluation revealed the presence of a large piece of wood sitting vertically 2 cm beyond the glottis. Although bronchoscopic removal of the wooden piece from the trachea was difficult and prolonged, it was successful. Following this process, he presented with subcutaneous emphysema and pneumothorax in the intensive care unit (ICU). After improvement with the aid of chest tube drainage in the ICU, he was discharged from the hospital on the 3rd day of rigid bronchoscopy. Early diagnosis and urgent removal of a foreign body are very important for reducing mortality. However, complications related to the foreign body itself or the bronchoscopy may occur. In conclusion, the physical characteristics, position and location of the foreign body can influence the outcome, even in skilled hands.