Therapeutic approaches for inhalation of veil pins: local Egyptian experience

A new type of foreign body inhalation that is the veil and head scarf pin has recently become more common. Accidental inhalation of these pins can occur while holding them between the lips when putting on the veils or head scarfs. Veil pins are radio opaque and are therefore easily diagnosed by plain chest x-ray and or fluoroscopy (1). Foreign body aspiration in general is a well-known phenomenon, which is generally common during infancy. The nature of the inhaled foreign bodies in general is influenced by crop diversity, harvest season and sociocultural factors (2). This short communication is a retrospective analysis of 144 cases of inhaled veil pins between 1999 and 2006 in three centres, which are Mansoura University Hospital, The Emergency Hospital and a private hospital in Mansoura. The demographic, clinical, x-ray and therapeutic data were analysed, including the age and gender of the patients, symptoms and signs, and radiological and the rigid bronchoscopic findings. The diagnosis was made on the basis of chest x-ray and or rigid bronchoscopy. The inhaled veil pins were removed either with or without the use of extracting forceps. Attempts were made to remove the pins by rigid bronchoscopy under general anaesthesia. Three methods can then be used for removal. One end of the veil pin is grasped and pulled into the bronchoscope out under vision; (technique 1). An important point is that we teach the junior staff to make sure that they see the pin very well and that they are holding it without surrounding mucosa. Alternatively, the middle of the pin is pulled against the inner opening of the bronchoscope until it bends into a U-shape and then the middle of the bent pin is pulled out thus protecting the airway and lessening the chance of airway injury (technique 2). We introduced a third method to remove a foreign body from the airway using the rigid bronchoscope without forceps, but using postural drainage (technique 3). It is mainly a reuse and revival of the concept of postural drainage of the airways. The patients’ demographic, radiological and bronchoscopic data are shown in Table 1. The complications encountered during rigid bronchoscopy and the results of different attempts to remove the pins are given in Table 2. The success of different techniques is shown in Table 3. The mean age was 14 years. Most of the patients had a history of aspiration, choking and coughing. The most common presentation in our series was history of pin inhalation followed by sudden cough after choking. There were no specific clinical signs on examination, as this is a non-obstructing foreign body aspiration mostly of acute presentation requiring rapid intervention. Postero-anterior and ⁄ or lateral chest x-rays demonstrated the presence of foreign bodies in all cases (radio-opaque veil or scarf pins). These patients almost always presented early (within 1 week). After bronchoscopy, laryngeal oedema was recorded in 10 cases. Reversible cardiac arrest which was successfully resuscitated was reported in three cases. Major airway injury with massive bleeding and death was reported in one case and barotrauma requiring an inter-costal chest tube in three cases. First bronchoscopy was successful in 114 patients (79%). In three of the 30 unsuccessful cases, the foreign body was spontaneously rejected by coughing; therefore, a second attempt for removal by bronchoscopy was made in only 27 patients (18.8%); 13 of these attempts were successful. In the remaining 14 patients (9.7%), six pins were removed by a third attempt with bronchoscopy. Eight patients (5.6%) needed bronchotomy; no patient required pulmonary resection. Techniques 1, 2 and 3 were Acta Pædiatrica ISSN 0803–5253