Accidental hijab pin ingestion in Muslim women: an emerging endoscopic emergency?

When the Hijab causes death in workplace…: A case series

In eastern countries, Muslim females wear the Hijab, all the time, conforming to a moral standard of modesty and privacy. Worn in workplaces, the Hijab can causes accidents leading to death. In this context, we report three fatal work accidents related to the Hijab. In two cases, death occurred instantaneously. In all cases, death was attributed to mechanical asphyxiation.

Hijab Pin Ingestions

OBJECTIVES

To characterize the clinical manifestations, outcomes, and complications of hijab pin ingestion in adolescents and to identify risk factors for a need for intervention.

METHODS

A retrospective review of patients <25 years of age who presented to our emergency department because of hijab pin ingestion between 2007 and 2018. Comparison was performed between impaled and nonimpaled pins.

RESULTS

We reviewed 1558 foreign-body ingestion cases. Of these, 208 (13.3%) patients presented because of hijab pin ingestion, with a total of 225 ingested pins. The mean patient age was 14.7 ± 4.1 years, and 88% of patients were girls. Time from ingestion to presentation was 24 ± 49.5 hours. Most pins were located in the stomach (46.6%), and 18.6% of all pins were impaled. Location in the stomach (odds ratio = 4.3 [95% confidence interval: 1.9-9.2]; P < .001) and abdominal tenderness on examination (odds ratio = 2.7 [95% confidence interval: 1.3-5.6]; P = .007) were strong independent risk factors for an impaled pin. Time to intervention was 22.9 hours, and 41 endoscopies were performed. One patient required laparoscopic surgery. No complications were observed.

CONCLUSIONS

The hijab pin is an increasingly encountered foreign body in pediatric practice. Its specific clinical features distinguish it from other sharp objects. A delayed interventional approach in selected patients does not carry a higher risk of complications and results in significantly fewer interventions compared to existing guidelines. These findings will help guide pediatric specialists in this prevalent clinical scenario. Management recommendations are proposed.

Accidental ingestion of hairpin in an adolescent girl

Ingestion of headscarf pin is a particular type of foreign body ingestion sometimes experienced by adolescent girls and even older women while putting on their headscarf. We report on a 13-year-old girl who presented at the emergency unit at our hospital within 48 hr after accidentally swallowing a headscarf pin. The pin was successfully retrieved from the ascending colon through colonoscopy. Headscarf pin ingestion is a serious problem among women who wear headscarves for various reasons. However, the retrieval of such pins from the colon through colonoscopy has been infrequently reported.

Management of Ingested Hijab-Pin

BACKGROUND AND STUDY AIMS

Accidental swallowing of hijab (or turban) pin was reported mainly among adolescent girls. Current guidelines indicate emergent intervention endoscopy in case a long sharp object is found in the gastrointestinal tract. The aims of the current study are to present the results of an observational approach and to assess the need for intervention.

PATIENTS AND METHODS

A retrospective cohort study was conducted including all 5-18-year-old patients who presented with hijab-pin ingestion between 2003 and 2014. The need for intervention was assessed using both univariable and multivariable statistical analyses.

RESULTS

Two hundred three cases of hijab-pin ingestion were documented. In the majority of cases, the pin was observed in the stomach (137/203, 67.4%) upon arrival. Most pins that were located at the upper gastrointestinal tract (proximal to the ligament of Treitz) ejected spontaneously (120/169, 71%, Pv = 0.005). The absence of pin progression in an X-ray performed 12 h following presentation was significantly more frequent in the intervention group (46/51, 90%, Pv = 0.001).

CONCLUSIONS

In most cases, the outcome is spontaneous ejection from the digestive tract. However, if needle location remains unchanged on two consecutive X-rays, an endoscopic intervention is recommended.