Foreign body (FB) aspiration is a very common problem among the pediatric population results in acute respiratory complications. Most foreign bodies are organic and fragile in nature and during their retrieval, it may break into pieces and get dislodged in the airway results in additional complications. Here we report a case of two year old child with the history of recurrent lung infection. On admission child had decreased air entry on right side with SpO2 88-90% on room air. Chest X-ray was suggestive of hyper inflated right lung fields with normal left lung fields. Provisional diagnosis of foreign body airway was made and diagnostic bronchoscopy under general anaesthesia was planned. 

Bronchoscopy revealed that left side bronchus had no evidence of FB, while right main bronchus had a yellow colored foreign body. After careful retrieval of the foreign body from right main bronchus, SpO2 reduced from 98% to 90% on 100% oxygen with grossly decreased air entry on the left side. Given a new finding in the chest and a significant reduction in SpO2, a check bronchoscopy was decided and performed immediately which revealed no FB in the right bronchus, while in the left main bronchus a new FB was detected which was not present before. 

On examination, it was observed that new foreign body retrieved from the left main bronchus was a part of the foreign body removed from the right main bronchus. In fact, during retrieval of FB (fragile) from the right main bronchus, it broke into two pieces and one piece slipped into the left main bronchus resulting in immediate complication. 

Therefore, bilateral check bronchoscopy is being suggested following retrieval of the foreign body from the airway to rule out other FB or slipped parts of the retrieved foreign body to avoid further complications.

Ankita Kaasat has done her MBBS and MD from reputed colleges of Delhi University. She also has additional DNB and IDRA degree. She has done her senior residency from premium institutes. At present she is working as Associate professor at Ananta Institute of Medical Science and Research Centre (Rajasthan University of Health Sciences) in Rajasthan. She has various national and international publications. She is a regular reviewer of various national and international journals.