Headscarf needle aspiration is a rare event, especially in Middle and Western European countries. Here, we report the case of a 37-year-old Austrian woman of Turkish origin who accidentally aspirated a turban pin. Repeated bronchoscopy was not successful in removing the aspired foreign body, which extended past the right middle lobe to the interlobar fissure. The needle was finally removed by video-assisted thoracoscopic surgery.

The extraction of aspirated foreign bodies can prove challenging at times, requiring even rigid bronchoscopy. Cryotherapy probes have been reported to help with extraction of foreign bodies. We present a case where successful "cryoextraction" was performed on an aspirated chewing gum. The case highlights the fact that this technique is useful to extract all materials that have water content. This technique can be performed through flexible bronchoscopy and can save patients from more aggressive approaches.

Persistent or recurrent pneumonia in children can pose a significant challenge to paediatricians and respiratory physicians.The aim of this study is to determine the role of flexible bronchoscopy (FB) in evaluation of recurrent or persistent pneumonia that remain otherwise unexplained by non-invasive diagnostic tests in children.Retrospective evaluation of patients who underwent FB with an indication of recurrent or persistent pneumonia from 1997 to 2011.Among 2600 FB procedures, 434 (17%) were performed with the indication of recurrent or persistent pneumonia. There were 237 (54%) boys. Median age at presentation was 84 months, and median duration of symptoms was 9 months. FB led to specific diagnosis in 33% of the cases. The most common diseases diagnosed by FB were malacia disorders (n: 32, 7%), aspirated foreign body (n: 30, 7%), endobronchial tuberculosis (n: 20, 5%), congenital airway anomalies (n: 14, 3%), mucus plugs (n: 14, 3%), pulmonary haemosiderosis (n: 12, 3%) and middle lobe syndrome (n: 11, 3%). During FB, only 6% of the patients had minor complications such as transient hypoxia, stridor and tachycardia.In our study, FB proved to be a safe and effective tool in evaluation of children with persistent or recurrent pneumonia. FB is indicated for children with recurrent or persistent pneumonia where the underlying diagnosis remains unclear even after non-invasive diagnostic tests.

A 16-year-old boy who had aspirated a straw came to the Emergency Ward. The only symptom was a soft whistling sound while breathing. The straw was found in the right middle lobar bronchus and was removed by flexible bronchoscope and forceps. Prompt removal of foreign bodies from the airways, preferably by flexible bronchoscopy, is necessary to avoid complications.

Foreign body aspiration can infrequently occur following trauma. Tooth aspiration after trauma is a rare clinical scenario. Here, we report a case in which tooth aspiration after trauma led to a presentation of acute respiratory failure with clinical findings mimicking tension pneumothorax. Successful removal of the aspirated tooth was accomplished by rigid bronchoscopy. Tooth aspiration must be considered in the list of differential diagnosis for any patient having signs or symptoms of respiratory distress following trauma especially maxillofacial trauma.

Foreign body (FB) inhalation into airways of the respiratory system is a life-threatening condition and can be fatal. The purpose of this survey was to evaluate the types and characteristics of inhaled foreign bodies, the age distribution of children, and the outcome.We outlined a retrospective review of hospital data of patients between 1990 and 2012. FB inhalation occurring in children 0 year to 16 years was considered for inclusion. During the study period, 1,660 patients undergoing bronchoscopy with the diagnosis of FB were included. Deaths on arrival were excluded.Of the patients, 53% were male, and 47% were female (p > 0.05). The mean age was 6.2 years for girls and 4.7 years for boys. In 57% of all cases, the children were younger than 3 years. An FB was found within the respiratory tract of 1,565 patients. The FBs were always extracted by using rigid bronchoscopy. Hospitalization was always required owing to an institutional requirement. The origin of the FBs were within the two main groups of food and objects. Food FBs included seeds, nuts, beans, and fruit parts. FB objects included pins, toy parts, and metal pieces. FB and subsequent treatment revealed that morbidity was present; however, mortality was rare.Most of the inhaled FBs were found in the bronchial tree. Children younger than 3 years are more vulnerable. There seemed to be an association between the aspirated FBs and season, geographic locality, and sociocultural environment. The removal of choice is rigid bronchoscopy under general anesthesia. That most cases of FB in children occurs under the supervision of adults indicates that the incidence and severity of airway FB inhalation can be reduced by parental education and public awareness.Epidemiologic study, level III.

Inguinal hernia repair is one of the most common procedures performed by pediatric surgeons. A percutaneous technique could be the next advance in inguinal hernia repair in children. We used a rat model to study the utility of percutaneous inguinal hernia repair (PHR) using 2-octyl-cyanoacrylate (OCT).Four-week-old Lewis male rats were randomly divided into three groups: bilateral PHR group (BH) (n=15), unilateral PHR group (UH) (n=12), and sham group (n=14). After inducing a pneumoperitoneum, a 24-gauge cannula was advanced into the patent processus vaginalis (PPV) once air was aspirated. The canal is then obliterated by injecting 0.2 ml of 2-octyl-cyanoacrylate. Mating and herniography were performed at postoperative weeks 2 and 6, respectively. All rats were sacrificed at week 12.Herniography revealed complete closure of PPV in (25/30) BH, (12/12) UH, and (0/28) of the sham group. All OCT-treated sides were found obliterated at the post-mortem gross examination. Histological analysis of the inguinal region revealed patent vase in all rats. However, mild to moderate foreign body reactions and fat necrosis were noticed at the injected sites. All rats demonstrated fertility at mating.Percutaneous obliteration of PPV was feasible and safe in rats and potentially less invasive than the current techniques used in children. However, demonstrating long-term effectiveness, the need for pneumoperitoneum and the risk of OCT intraperitoneal spillage remain as challenges to overcome.

Safety pins are not commonly aspirated objects in infants and form only a small fraction of all the metallic foreign body (FB) which accounts for 4.4% of all foreign bodies found in tracheobronchial tree. Bronchoscopy procedure has various complications, in addition to failure to remove FB due to its impaction, especially with metallic pointed objects ending up in open surgical removal. Infant with inhaled foreign body are always a challenge to anaesthetist. We had one such case of broken safety pin impacted in the wall of right bronchus of an infant with failure to remove on repeated attempts at rigid bronchoscopy.

We describe the case of a previously well young man who presented acutely to hospital with a history of progressive chest symptoms and systemic upset. At admission, clinical evidence of left upper lobe collapse on respiratory examination and chest x-ray gave rise to significant clinical concern. Initial assessment by CT suggested a possible aspirated foreign body in the left upper lobe bronchus with distal left upper lobe collapse. Subsequent rigid bronchoscopy identified a solid abnormality totally occluding the left upper lobe bronchus, which did not appear to be a foreign body. The patient became progressively more unwell with clinical signs of chest sepsis and failed to settle with medical therapy. A decision was made to undertake a lobectomy to remove the collapsed lobe and obstructing endobronchial lesion. Histology confirmed that the cause of bronchial obstruction was a mesenchymoma (pulmonary hamartoma).

Injury due to foreign body (FB) aspiration and/or ingestion is a common and serious pediatric emergency. Foreign body injury (FBI) most commonly occurs in children younger than 6 years, and the incidence of FBI has increased in recent years. The aim of the present study was to evaluate and compare the characteristics of FBI due to ingestion and aspiration.Data from patients who were hospitalized for FB ingestion and/or aspiration and underwent rigid bronchoscopy and esophagoscopy from 2008 to 2011 were retrospectively evaluated. Foreign body in the upper aerodigestive tract was evaluated with respect to the characteristics of patients, clinical presentation, management strategy, the outcome, and features of FB.A total of 192 patients admitted for FB ingestion or aspiration in the pediatric surgery department were evaluated. The mean age was 40.97 (SD, 35.73) months. The majority of patients were younger than 4 years. Foreign bodies were mainly located in the upper esophagus for ingested FBs (60.8%), whereas for aspiration 43% of FBs were in the main right bronchus. A total of 4 patients died. The hospitalization period of patients admitted for FB aspiration was longer than that of patients with FB ingestion. Surgery was performed in 4 patients. The most commonly ingested FBs were coins, whereas seeds were the most commonly aspirated.Prevention is the key to dealing with FBIs. Because the frequency of foreign bodies is higher in underdeveloped countries, education of parents regarding the dangers and prevention of aspiration and ingestion is important.