Challenges in Pediatric Foreign Body Aspiration: A Case Report on Persistent Bronchial Obstruction and Aspiration Pneumonia

Foreign body aspiration is a common and potentially dangerous event in young children, often leading to emergency department visits. Our case study presents a 2-year-old boy who aspirated multiple nuts, leading to choking and respiratory distress. The child initially experienced cyanosis and was later found to have decreased air entry on the right side of the chest, prompting the need for bronchoscopy. The initial tolerance for the procedure was low, with frequent loss of saturation, and despite multiple attempts, the bilateral and deep nature of the foreign body resulted in the child being intubated and admitted to the Pediatric Intensive Care Unit (PICU). Over the following days, the child underwent multiple combined bronchoscopies, utilizing flexible and rigid and a staged approach to clear the lungs. This was a combined treatment alongside antibiotics and dexamethasone for inflammation and infection prevention. The child experienced behavioral changes post-extubation, managed with psychiatric support and physiotherapy. This case emphasizes the need for early intervention, the importance of an interventional toolkit, and, at times, multidisciplinary or combined approaches to ensure complete recovery from foreign body aspiration incidents in children.