City docs remove pin stuck in 12-year-old child’s chest
   Date :19-May-2019

 Dr Jitendra Hazare, Dr Shilpa Hazare, Dr Bhau Rajurkar and
paramedical staff with the patient and her mother. (Inset) The pin.
 
Principal Correspondent:
 
Bronchoscopy played important role in removal of the foreign body
 
 
A team of doctors in Nagpur’s hospital removed a pin that was stuck in the chest of a 12-year-old girl successfully by performing bronchoscopy which is a difficult procedure. The girl came to Getwell Hospital, Dhantoli, with history of swallowing a pin (Tachni) used for fixing hair. It was supposedly two inches long and one end had a pearl while the other end was pointed. The girl had kept it in the mouth while adjusting the hair. Somebody asked her something and with the pin in mouth, she tried to speak. This action led to her swallowing of the pin. She had a bout of cough, and considering the seriousness, was taken to the doctor where an X-ray was performed.
 
The X-ray showed the pin lying obliquely in the chest, suggesting the pin to be in trachea (airway). “This is an extremely dangerous position, specially with a pointed edge, with a pin prick puncture of airway/ lung leading to air leak and danger to the life. Removal became necessary and urgent thing, as with bouts of cough the needle point could move and puncture some vital organ,” Dr Jitendra Hazare, Paediatric Surgeon expressed fear. After explaining the risks to the relatives of the girl, a rigid ventilating bronchoscope was used under general anaesthesia, and the pin was located. It was lying in the trachea with the pearl distal and the pointed tip pointing upwards, complicating the extraction.
 
Mal-aligned withdrawal could have lead to a tear in the airway by the sharp tip. An optical forcep was used to disimpact and then the tip was grasped to protect the airway. It was carefully withdrawn in the sheath of the scope as a protective cover, and the whole assembly removed. “With God’s grace, exceptionally critical anaesthesia was given by Dr Bhau Rajurkar. The backup of flexible bronchoscopist Dr Shilpa Hazare and good equipment, the procedure was performed safely,” pointed out Dr Jitendra Hazare. With excellent team of doctors who have expertise in paediatric/adult rigid scopy - Dr Jitendra Hazare, Pediatric Flexible Bronchoscopy - Dr Shilpa Hazare, and Adult Bronchoscopy - Dr Rajesh Swarnakar, and all supported by Dr Bhau Rajurkar, Chief Anaesthesiologist the procedure was performed.
 
The help of sisters working in Operation Theatre (OT) and technicians also played an important role. “All our nurses, technicians are experienced in tackling different and unforeseen problems which need improvisations and use of variety of equipment, which enable us to tackle different and varied types of foreign bodies in children, safely,” explained Dr Hazare. The prevention aspects As is said frequently, Prevention is better than cure, awareness amongst parents can help reduce the incidence of this dreaded and life threatening condition.
 
Dr Jitendra Hazare has some advice to provide to the parents. Giving nuts, peanut, Chana-gram, cashew- kaju, almonds- badam, bettlenut - supari, and fruits with seeds (Sitafal) to young children who do not have molars, chewing teeth, leads to these children swallowing these things rather than chewing, and accidentally the fragment enters the airway, and can lead to severe respiratory distress and many times death due to airway obstruction, if not treated in time, cautioned Dr Hazare. “Our elders have always warned us against talking with food in our mouth, as a bad habit in all probability knowing that this predisposes to aspiration of food in airway. Keeping pen caps, coins, supari, etc in mouth should be discouraged as accidentally person may be called and he/she responds instinctively and accidentally aspirates it,” pointed out Dr Hazare.