The Wandering Obstruction: A Case of Migratory Foreign Body in the Pediatric Airway

Abstract

Introduction

Foreign body aspiration in children is a common yet potentially fatal event, particularly in those under three years of age. Due to their natural tendency to explore objects orally, infants and toddlers are at an increased risk of airway obstruction. This report highlights a case of a migratory foreign body in the bronchus, emphasizing the diagnostic and management challenges encountered.

Case Report

A 1-year-old male presented with cough and respiratory distress persisting for three days. Despite initial treatment with antibiotics and oxygen support at an outside hospital, his condition did not improve. Although no clear history of foreign body aspiration was given, further questioning revealed a prior choking episode. Clinical examination suggested left bronchial obstruction, but HRCT thorax unexpectedly showed an isodense foreign body in the right main bronchus. Intraoperatively, rigid bronchoscopy revealed a large, smooth-surfaced Sitaphal seed lodged in the left main bronchus, indicating migration. Successful removal was achieved despite the retrieval challenges, and the child recovered well postoperatively.

Conclusion

This case underscores the importance of maintaining a high index of suspicion for foreign body aspiration in children with unexplained respiratory distress. Migratory airway foreign bodies can lead to dynamic clinical and radiological findings, necessitating careful preoperative assessment and intraoperative preparedness. Rigid bronchoscopy remains the gold standard for both diagnosis and management.