WOFAPS 2025 8th World Congress of Pediatric Surgery

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Poster - 56

Combined Use of Rigid and Flexible Bronchoscopy in Challenging Pediatric Foreign Body Aspiration Cases

Emine Burcu Çığşar Kuzu 1, Yusuf Alper Kara 2, Bade Toker Kurtmen 1
1 Department of Pediatric Surgery, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
2 Izmir City Hospital Pediatric Surgery Clinic

Introduction

Rigid bronchoscopy (RB) remains the gold standard for the treatment of foreign body aspiration (FBA). However, in young children and cases with distally located foreign bodies (FBs), limitations in the diameter and flexibility of rigid instruments may hinder access and retrieval. Flexible bronchoscopy (FB), with its smaller diameter and flexibility, offers advantages in reaching FBs lodged in narrow distal airways. This study aims to evaluate the outcomes of cases where both RB and FB were used in combination for FBA management.

Methods

We retrospectively reviewed the medical records of patients who underwent bronchoscopy for FBA between May 2024 and June 2025. Demographic data, clinical findings, and operative details were analyzed for cases where FB was used as an adjunct during RB.

Results

A total of 45 patients were evaluated. In 41 patients, FBs were removed successfully using RB alone. In 5 cases, RB alone was insufficient, and FB assistance was required. The mean age of these 5 patients was 15 months (range: 8–20). The median duration between aspiration and bronchoscopy was 105 days (range: 2–420). The FBs were located in the basal segments of the right lower lobe (n=3) and the distal right main bronchus (n=2). In two patients, FBs were removed using a basket or grasper inserted through the FB alone. In the remaining three cases, FBs were mobilized proximally using FB and removed with RB. All FBs were of organic origin. Post-removal inspection of distal bronchi was performed using FB.

Conclusion

The availability and timely use of a flexible bronchoscope during rigid bronchoscopy can facilitate successful removal of foreign bodies, particularly in challenging cases with distal airway involvement. This combined approach enhances procedural success and may reduce the need for repeat interventions.

Keywords: foreign body aspiration, rigid bronchoscopy, flexible bronchoscopy, combined technique, distal airway obstruction.

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