Extraction of Pins from the Airway with Flexible Bronchoscopy

Abstract

Background: Tracheobronchial foreign body aspiration is a worldwide health problem which often results in life threatening complications. Standard flexible bronchoscopy (FB) is used increasingly in the treatment of tracheobronchial foreign body aspiration in adults and older children, especially in the removal of aspirated foreign bodies which have entered into the peripheral bronchi. Objectives: In the present study, we discuss how to minimize complications and increase the success rate of FB in the aspiration of pins, and recommend techniques to facilitate the application. Methods: The study was performed at a community hospital in Van, the Harran University Hospital in Sanliurfa and the Sutcuimam University Hospital in Kahramanmaras, Turkey. Between 2000 and 2005, 23 female patients between the ages of 12 and 23, who were admitted to the clinics and diagnosed as having tracheobronchial headscarf pin aspirations were included in our study to evaluate the efficiency of FB. Diagnosis of the patients was established by history, FB and radiological methods. All patients received transoral FB under local anesthesia. Results: FB was successfully applied in all cases. During removal, the pins in 2 patients dropped at the proximal trachea and subglottic zone, and were ingested into the gastrointestinal track. In both cases, the pins were spontaneously excreted from the body in the stool within one day. No other complication was detected in the other patients during or following bronchoscopy. Conclusions: Our study suggests that FB is a safe, easy and successful method used in the removal of foreign bodies, such as pins, from the tracheobronchial trees. By employing FB, indications of thoracotomy and other invasive methods can be reduced especially in the cases of pins localized in distal airways and in the evaluation of suspected foreign bodies.

Anaesthestic Management of Removal of Aspirated Hypodermic Needle in Trachea: A Case Report

“…Though aspiration of hypodermic needle has been reported previously mostly in drug addicts [5,6], but aspiration of needle used for local anaesthesia for dental procedure and its successful removal using RB has not been reported previously as far as our knowledge goes. We understand a single case report does not have much educational value in medicine, but this case report shows us that one should be cautious during use of hypodermic needle as it can get displaced and aspirated into the airway.…”

“…Parkinson's disease), cervicofacial trauma, sedation or intoxication [2,4]. Most common foreign bodies (FBs) in adults are organic like bones, food particle [2,4,5], bean, seeds; [2] whereas inorganic FBs can be dental prosthesis, pills, tops of beverage cans, turban pins [2,4]. In adults aspirated FB most commonly lodge in the right bronchus because of its vertical nature [2][3][4].…”

“…Other symptoms can be cough, fever, breathlessness, wheezing and cyanosis [2][3][4]. Most common clinical finding in AFB is unilateral or bilateral decreased breath sounds, stridor and localized wheeze [5]. Though most of the FBs are radiolucent, but an anterio-posterior and lateral chest and neck X-ray should be obtained in all the cases [2,5].…”

“…Most common clinical finding in AFB is unilateral or bilateral decreased breath sounds, stridor and localized wheeze [5]. Though most of the FBs are radiolucent, but an anterio-posterior and lateral chest and neck X-ray should be obtained in all the cases [2,5]. Computerised tomographic scan [3,4] and virtual bronchoscopy can be very helpful and confirmatory in diagnosing the location of aspirated FB [3].…”

“…Management consists of resuscitation and bronchoscopic removal of the FB [2,4]. Though rigid bronchoscopy (RB) is the standard of care in children with AFB, but flexible fibreoptic bronchoscopy (FOB) is increasingly being used both for diagnostic and therapeutic management of AFB in children and adults [1][2][3][4][5]. But for sharp AFB RB is still the standard of care [1].…”