# Nine Months With a Pin: Thoracotomy After Repeated Bronchoscopic Failures in a 16-Year-Old With Hijab Syndrome

## TL;DR

A 16-year-old girl required surgery to remove an inhaled pin after multiple bronchoscopic attempts failed, highlighting the need for timely surgical intervention in such cases.

## Contribution

This case highlights the rare need for thoracotomy after repeated bronchoscopic failures in managing inhaled foreign bodies.

## Key findings

- Thoracotomy successfully retrieved a pin after nine months and multiple bronchoscopic failures.
- Chronic cases with endoscopic failure require surgical escalation for optimal outcomes.
- Clear criteria for transitioning to surgery are essential for patient safety and communication.

## Abstract

Inhaled sharp foreign bodies, such as pins, are commonly managed through bronchoscopic retrieval. However, challenges arise when such efforts fail, requiring escalation to surgery. We report a rare case of a 16-year-old female who presented nine months after inhaling a pin. During this period, multiple bronchoscopic removal attempts were unsuccessful. Imaging localized the foreign body to the middle lobe of the right lung. Given the chronicity of the case and endoscopic failure, the patient underwent thoracotomy, through which the pin was retrieved. The postoperative course was uneventful, and she was discharged without complications. This case underscores the importance of recognizing the limitations of bronchoscopy and the need for timely transition to surgery. Establishing clear criteria for escalation to thoracotomy is essential to optimize outcomes and ensure effective communication with patients and families.