[Rigid bronchoscopy for pin extraction in children at the Children's Hospital in Rabat, Morocco]

Head Scarf Pin in the Airway and Challenges in Rigid Bronchoscopy: A Case Series

Accidental Foreign body aspiration, especially sharp metallic objects may lead to life threatening complications. A metallic object is identified readily on a Xray chest or CT chest and helps us in ascertaining its location. A straight pin with blunt head in the shape of pearl is used in wearing a head scarf also known as hijab to hold it in place. The head scarf pin (hijab pin) if accidentally aspirated into the airway may lead to grave complications. Hence timely intervention with suitable instrumentation is essential to prevent any lethal complications. We have reported four different cases of adolescent females who had accidentally aspirated hijab pin and challenges faced by us during removal.

Accidental inhalation of scarf pin: Presentation and management

Background:

The accidental aspiration of foreign bodies (FBs) is a rare occurrence in adults. However, inhalation of scarf pin is a phenomenon more and more common in the context of Muslim nations. The aim of our study was to describe the characteristics of this particular FB and illustrate the circumstances and consequences of inhalation.

Methods:

This retrospective study involved patients with a history of scarf pin aspiration admitted to the Thoracic Surgery Department of Mohammed VI University Hospital Center, Oujda, Morocco, over a period of 10 years. Their main presentation, diagnosis, treatment, and outcome were analyzed.

Results:

The average age of the 30 cases was 18 years (13–43). No antecedent was found in all cases. The penetration syndrome was found in all cases, with a transient moment of suffocation in 19 cases (63.33%), a dry cough in 15 cases (50%), minimal hemoptysis in 4 cases (13.33%), and purulent sputum in 3 cases (10%). The clinical examination was normal in all cases. The chest X-ray showed the FB in the form of linear right sided opacity in 14 cases (46.66%), left sided in 8 cases (26.66%), and in the trachea in 8 cases (26.66). Rigid bronchoscopy visualized the scarf pin at the level of the right basal pyramid in 5 cases (16.66%) and on the left side in 2 cases (6.66%), at the level of the main right and intermediate trunk in 7 cases (23.33%), at the level of the left main bronchus in 4 cases (13.33%) and in the trachea in 5 cases (16.66%). The pin was extracted by rigid bronchoscopy in 23 cases (76.66%) and was expelled spontaneously in 5 cases (16.66%). Thoracotomy was required in 2 cases (6.66%). Medical treatment, including antibiotic therapy and short-course oral corticosteroids, was administered in all cases.

Conclusion:

Scarf pin inhalation is common in women who wear the Islamic headscarf. Bronchoscopy is an important tool to manage these FBs, but the best prevention treatment is careful handling of these potentially sharp objects away from the mouth.

Aspiration of hijab pin is sharply rising among young women---A preventable health problem

Introduction:

Foreign body aspiration is a common life threatening emergency but largely a preventable problem. There is an increase in the number of headscarf pin aspiration cases among young girls as a result of increase in the number of veiling population. With the number of hijab wearing population increasing all over the world, attention must be brought to the risk associated with holding the hijab pins in the mouth.

Aim:

To study the practice of holding hijab pin in the mouth among Muslim women.

Methods:

In a first study of its kind, we interviewed 270 Muslim women with varied background to study the practice of hijab pin use and holding it in the mouth.

Results:

Among 270 Muslim women, 260 (96.3%) of them wear hijab. 221 (81.85%) women use hijab pins to hold different layers of hijab. 191 (70.74%) of them hold the hijab pins in between the lips when they adjust the layers of hijab. 72 (26.67%) women had occasions when the hijab pin slipped into their mouth and 10 (3.70%) of them have aspirated the hijab pin accidentally. Maximum hijab pin use is in the age group between 21 and 40 years (89.44%) and least in the elderly (6.66%). Occasions when the pin slipped into the mouth or aspirations both are maximum in the below 20 years group. Both are nil in elderly.

Conclusion:

Appropriate education and intervention need to be planned as more young population are getting involved. Most importantly refrain from holding the pin in the mouth!

Accidental aspiration of head scarf pin in left bronchus piercing the lung parenchyma: A rare case in a child

Foreign body (FB) aspiration is commonly seen in children but less commonly in adolescents. Headscarf pin aspiration is common in Muslim girls, who inappropriately place the pins between their lips while securing the scarf on the head. Bronchoscopy is the treatment modality of choice, and surgery is rarely required. An 11-year-old girl was admitted as a case of accidental aspiration of headscarf pin. X-ray chest showed a radiopaque object in the left bronchus piercing the lung parenchyma. Computed tomography (CT) chest confirmed the diagnosis. The headscarf pin was removed by flexible bronchoscopy as the ear, nose, and throat (ENT) surgeon failed to remove it by rigid bronchoscopy. The FB was removed successfully and the patient was discharged home. Removal of a sharp pin by bronchoscopy is difficult, especially if it pierces the lung parenchyma. In our case, the pin was bent by forceps and then removed by a flexible bronchoscope, which requires a highly skilled professional.

[Epidemiology of severe domestic accidents of children admitted in pediatric intensive care unit of Children Hospital of Rabat-Morocco]

Introduction

Les accidents domestiques de l'enfant représentent un vrai problème de santé publique dans les pays industrialisés. Au Maroc, la priorité en santé publique est toujours donnée aux pathologies infectieuses, et bien qu'elle soit très peu décrite, la pathologie accidentelle de l'enfant devient de plus en plus fréquente dans notre pays avec une mortalité importante. L'objectif est de mettre le point sur la prévalence, la gravité, les aspects étiologiques, les facteurs de risque et les circonstances de survenue de ces accidents, ainsi que les moyens de prévention active et passive.

Méthodes

Enquête rétrospective descriptive sur une période de douze mois portant sur tous les enfants pris en charge pour accident domestique grave au service de réanimation pédiatrique polyvalente de l'hôpital universitaire d'enfants de Rabat.

Résultats

Parmi 698 admissions, 108 cas d'accidents domestiques graves ont étaient colligés (soit 15,5%), L’âge moyen des enfants était de 04ans tout accident confondu, avec un sex-ratio de 1,08 en faveur des garçons. L’évolution générale était marquée par le décès de 16 enfants (soit 14,8%) parmi 164 décès toute pathologie confondue au cours de la même période d’étude (soit 9,75% des décès) avec une durée moyenne d'hospitalisation de 04jours. les brûlures constituaient le premier accident dans notre série par 37cas, et elles étaient la première cause de mortalité par huit cas; par ailleurs, la population la plus à risque de brûlure était les nourrissons (67,6%). L'inhalation intrabronchique d’épingle à foulard (accident particulier dans notre contexte islamique) à été retrouvée chez six cas.

Conclusion

Les accidents domestiques de l'enfant constituent rarement une préoccupation de premier plan dans la population alors qu'ils sont parfois très graves et source d'une mortalité importante. Le meilleur traitement reste la prévention active et passive.

Scarf pin inhalation: clinical characteristics and surgical treatment

Objective

Scarf pin inhalation is becoming a frequent accident among young Moroccan woman who wears islamic veil. The aim of the study is to highlight indications, principles and challenges of surgical removal of that particular foreign body.

Methods

Twenty-eight patients were hospitalized in Thoracic Surgery department of Ibn Sina Hospital at Rabat between January 2008 and June 2013 for surgical removal of a pin scarf after unsuccessful endoscopy.

Results

Mean age was 20 years. Inhalation was accidental in all cases. Average interval between inhalation and surgery was 10 days. Penetration syndrome was found in 82% of patients. Pin was located at the left tracheo-bronchial tree in 53.5% of cases and at the right one in 46.4%. All were operated by thoracotomy. Surgery was conservative in all cases, and postoperative course was uneventful.

Conclusion

In case of failure endoscopic treatment, surgery remains the only alternative. It must be as conservative as possible. Short interval between inhalation accident and surgery prevents parenchymal resection.

Foreign body aspiration in children: experience from 2624 patients

OBJECTIVES

The objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria.

METHODS

In this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy.

RESULTS

The children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. The delay between aspiration and removal was 2-8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of vesicular murmur. The examination was normal in 13%. The most common radiologic finding was pulmonary air trapping (40.7%). The aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. The endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. The complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%.

CONCLUSION

Foreign body aspiration is a real public health problem in Algeria. The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff. The prevention of this domestic accident should consider the population lifestyle and cultural habits to be more effective.