Choking on pins, needles and a blowdart: Aspiration of sharp, metallic foreign bodies secondary to careless behavior in seven adolescents

SummaryObjectiveTo review the demographics, pathophysiology and management of aspiration of sharp, metallic foreign bodies; to review prevention strategies.DesignCase series and review of the related literature (1932–2006).SettingTertiary care pediatric hospital.PatientsAll patients presenting to BC Children's Hospital with aspiration of sharp, metallic foreign bodies since 1998.ResultsThe seven patients ranged in age from 11 to 15 years (mean 13 years). The two boys had been playing with other boys at the time of aspiration. One aspirated a thumbtack and one aspirated a homemade blowdart (which traveled from his carina to his subglottis with coughing). Three of the five girls had been holding thumbtacks or a darting pin between their lips while putting up posters or sewing. The other two girls, who aspirated thumbtacks, refused to provide a history. One was treated successfully 6 days after the aspiration. The other girl withheld the history for over a year, presented with hemoptysis and eventually required thoractomy and right main bronchotomy to remove the tack. All of the other patients were diagnosed and successfully treated by rigid bronchoscopy within 24 h. (Two patients initially had a failed attempt at foreign body removal by flexible bronchoscopy at another hospital.)This is the second largest series of aspiration of sharp, metallic foreign bodies since at least 1966. Adolescents are still aspirating sharp, metallic foreign bodies because of the same behaviors described by Jackson and Jackson in 1932. Education about choking hazards is needed for this age group.ConclusionsAspiration of a sharp, metallic foreign body is a serious injury which is best treated by rigid bronchoscopy. These injuries potentially could be prevented through education.