Tracheostomy-Assisted Retrival of Bullet from Right Main Bronchus: A Case Report

Background: Foreign body aspiration is a serious pediatric emergency that can cause severe morbidity and mortality. Early diagnosis and immediate are necessary to avoid complications. Case Presentation: A 5 years old boy presented with history of dyspnea, fever, cough and chest pain since 2 weeks after the ingestion of a bullet while playing. Clinical features were dyspnea, stridor and markedly reduced air entry on the right. A chest X ray revealed radio-opaque foreign body in the right main bronchus. An Emergency rigid bronchoscopy under general anaesthesia was not successful in the removal of the foreign body despite repeated attempts. Subsequently, a tracheostomy was performed and bullet removal was successful. Post-operatively, improvement was impressive, and on the 4th day, the patient was discharged in good condition. Conclusion: The case report describes about a difficult extraction of a foreign body from Right main bronchus, needing a tracheostomy at the end to retrieve the same in view of failure of extraction via rigid bronchoscope. Early diagnosis, appropriate imaging and a multidisciplinary strategy are important for effective management of foreign body aspiration in children. This case also highlights the limitation of rigid bronchoscopy and reminds us to be prepared for tracheostomy if required.