Use of Fiberoptic Bronchoscopy for Removal of Inhaled Endobronchial Headscarf Pins in Adults
AbstractBackground: Foreign body (FB) aspiration is a worldwide health problem which can result in a life threatening complications. It most commonly occurs among children younger than 4 years of age, yet inhalation of sharp foreign bodies are seen more commonly in adults. Headscarf pin inhalation is a common and unique form of foreign body inhalation among young Moslem women wearing a hijab. Standard flexible bronchoscopy (FOB) is used increasingly in the treatment of tracheobronchial foreign body inhalation in adults and older children, especially in the removal of inhaled foreign bodies which have entered into the peripheral bronchi. Objectives: The aim of this study is to investigate the success rate of fiberoptic bronchoscopy (FOB) in endobronchial headscarf pin removal, how to minimize complications, and recommend techniques to facilitate the application. Patients and methods: Patients with the diagnosis of headscarf pin inhalation admitted to Al-Kadhimyia teaching hospital, department of cardiothoracic and vascular surgery from January 2013 to September 2014 were included in the study. Standard FOB procedure using an oral approach in recumbent position under local anesthesia and conscious sedation was performed as the primary tool for retrieval, the process was not repeated when the foreign body could not be removed. In these cases, the foreign body was removed by rigid bronchoscopy under general anesthesia. A total of 19 cases were admitted during the study period. The mean age of the sample was 23.16 years (13-45 years). Twelve patients presented with cough (63.16%) while only one patient had hemoptysis (5.26%), four. Results: patients had chest pain (21.05%) and two patients had dyspnea(10.53%).Retrieval of the inhaled pin by fiberoptic bronchoscopy was successful in 17 patients (89.47%). In one patient (5.26%) FOB was not successful so the FB was removed by using rigid bronchoscope under general anesthesia while thoracotomy was performed in one patient (5.26%) after unsuccessful attempts of both FOB and rigid bronchoscope. Conclusion: Sharp pin inhalation is a serious hazard and can have lethal outcome. It is a common form of tracheobronchial FB inhalation among young Muslim females who have the habit of holding the pin between their lips or teeth while doing or undoing their headscarves. This results in accidental sudden inhalation while talking or laughing. Flexible FOB under conscious sedation and local anesthesia can be a useful first- step tool in retrieving inhaled headscarf pins, especially in distal airways, in adolescents and adults in the hands of an experienced bronchoscopist and a well-equipped bronchoscopy unit.
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