Unique Challenges to the Approach and Management of Pediatric Headscarf Pin Aspiration

Headscarf use is becoming more common throughout the world. Many articles describe the problem of aspirated headscarf pins but few if any give technical details for retrieval or innovative methods of removal if traditional bronchoscopy fails particularly in the pediatric population. Herein, we describe our method of deep sedation with laryngeal mask airway (LMA) and flexible bronchoscopy (FB) and retrieval with a stepwise algorithm if traditional FB fails.

A retrospective review of pediatric patients with aspirated headscarf pins was performed. Patient demographics, symptomatology, procedure specifics, and outcomes were recorded.

Fifty-six patients had pins removed at our institution between January 2010 and May 2017. Ninety-one percent were female. Each had a history of aspiration of a needle confirmed by a chest X-ray. The most common presenting symptom was cough in 48%. Only a small minority had physical exam findings (9% either wheezing or decreased air entry). FB via LMA under deep sedation was used as a primary intervention and was successful in 52 of 56 cases (93%). Fluoroscopy was added to aid the FB in 3 cases and was successful in 2 of the 3 patients. Two patients underwent mini-thoracotomy for removal. All pins were removed successfully and none of the patients had any postprocedural complications.

Surgeons caring for pediatric patients throughout the world should be knowledgeable in a common problem often facing girls wearing headscarves. Given the majority of the needles are in segmental bronchi in teenage girls, we recommend FB as the primary modality with the addition of fluoroscopy to guide if needed and video-assisted thoracoscopy or mini thoracotomy if less invasive methods fail.