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The inhaled pin inaccessible to the bronchoscope: a management conundrum

Published online by Cambridge University Press:  20 May 2009

D V T Harischandra ,
J Swanevelder  and
R K Firmin
D V T Harischandra*
Affiliation:
Department of Cardiothoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
J Swanevelder
Affiliation:
Department of Anaesthetics, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
R K Firmin
Affiliation:
Department of Cardiothoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
*
Address for correspondence: Dr D V T Harischandra, Department of Cardiothoracic Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. Fax: +44 (0)116 2321720 E-mail: tolushah@yahoo.co.uk
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Abstract

Objective:

The inhaled sharp foreign body is usually amenable to bronchoscopic extraction. When this fails, management poses a challenge. We present a logical approach to the inhaled pin inaccessible to the bronchoscope.

Case report:

A 12-year-old girl presented to the accident and emergency unit after accidentally inhaling a pin. Multiple attempts with both rigid and flexible bronchoscopy failed to access the pin, which had lodged distally in the anteromedial basal segment of the left lung. Eventually, the pin was extracted at thoracotomy.

Conclusion:

We discuss the reasons for extracting such pins, as opposed to leaving them in situ, and when to proceed from endoscopy to open surgery. Such knowledge is useful, not only to guide the multidisciplinary team in their combined approach to this unique challenge, but also to explain to the patient the rationale for the proposed treatment protocol.

Keywords

Respiratory AspirationForeign BodiesBronchoscopyThoracotomy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 12 , December 2009 , pp. 1399 - 1401
Copyright
Copyright © JLO (1984) Limited 2009

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Footnotes

Presented at the 6th Annual Academic Sessions of the College of Otorhinolaryngologists and Head and Neck Surgeons of Sri Lanka, 19 October 2008, Colombo, Sri Lanka.

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