Pyriform sinus perforation during nasotracheal intubation: a case report

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Endotracheal intubation is the commonest technique in medical practice with a low complication rate.

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Physicians performing endotracheal intubation or dealing with patients after intubation, should be aware of the clinical symptoms of such complications.

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Early diagnosis is the mainstay improving the outcome and avoids the morbidities and life-threatening course potentially.

Introduction

Endotracheal intubation is the gold standard to protect the airway during general anesthesia. It is the commonest technique in medical practice with a low complication rate.

Presentation of case

We report a case of left pyriform fossa perforation in a child after apparently uneventful nasotracheal intubation for tonsillectomy.

Discussion

This is a rare complication. Physicians performing endotracheal intubation or dealing with intubated patients should be aware of the clinical symptoms of such complications. A rational management approach has been discussed.

Conclusions

Early diagnosis is the mainstay to improve the outcome and avoid the morbidity and potentially life-threatening course of such trauma.

Foreign body Swallows with Airway Affection in Pediatrics

Aims

The current work aimed at evaluating how FBI can cause respiratory distress and stridor as well as their severity according to age, gender, lodgment site, and type of the object. Factors influencing morbidity and mortality among studied patients will be deliberated as well.

Methods

It is a hospital-based descriptive study where all children between birth and 16 years of age who were admitted to Sohag University Hospital, Egypt from January 1st, 2018, to December 31st, 2020, for FBs removal were analyzed. All cases were subjected to complete history taking, physical, radiological, and bronchoscopic examination.

Results

A total of fourteen [14] patients were presented with FBI based on a full history, examination, and essential investigation. The vast majority 92.9% of presented cases (13 out of 14) were less than 6 years old. 50% of them (50%) (7 out of 14) were less than one year old. Most cases presented early within a few hours after ingestion (71.4%). Two [2] patients had predisposing conditions like mental retardation and cerebral palsy. 28.6% of cases presented late (> 24 h after aspiration). Except for one case where a cervical oesophageal approach was needed. Endoscopic extractions of foreign bodies were successfully done. 50% of patients required admissions to the Pediatric Intensive Care Unit (PICU). The mortality rate was 14.3%.

Conclusion

FBI is a common clinical emergency in children younger than 6 years. A high index of suspicion is the keystone for diagnosis. Early detection and management are crucial for a positive outcome.