Helena Phillips

On-the-spot innovation

Helena Phillips’ X-ray – with a straight pin lodged deep in her right lung – is one of those pictures worth a thousand words.

The 15-year-old’s tale began while she was sticking a photo to her bedroom bulletin board with a pin. Like so many of us do, Helena stuck the pin between her lips to free her hands. You can guess what happened – it quickly slipped down her trachea when she took a breath.

“I wasn’t sure at first if I swallowed it,” recalls Helena. She later learned that lungs do not have nerve endings, making it difficult for her to feel the pin. “I searched the floor but didn’t find anything. I told my mom that I thought I just did something horrible! I was very scared.”

Helena’s parents immediately drove her from their Kerman home to Children’s emergency department where an X-ray confirmed their fears. Helena had aspirated the pin. Emergency department physicians called in Dr. Lauro Roberto, a pediatric pulmonologist at Children’s.

“We knew we couldn’t leave the pin in there,” says Dr. Roberto, pointing to Helena’s X-ray. “Chances are the injury from the pin could fester or get worse.”

Dr. Roberto tried to retrieve the tiny object using a bronchoscope, but the instrument could only go so far, reaching to just a millimeter from the pin. The other alternative was surgically removing part of Helena’s lung, but Dr. Roberto didn’t care for that option. “I didn’t want to give up,” he says.

Doctors take a different approach

Dr. Roberto decided to try a technique that a pulmonologist and cardiologist at Children’s used to retrieve a pushpin from a teenage boy. In that case he used a bronchoscope, catheters and guide wires, watching them simultaneously on an X-ray screen, to extract the pushpin. It was a rare combination of tools usually used for separate pulmonology and cardiology procedures.

Rather than run the bronchoscope and catheter parallel, however, Dr. Roberto and Dr. Carl Owada, medical director of cardiac catheterization at Children’s, actually placed the smaller catheter inside the bronchoscope.

Once the bronchoscope reached its previous spot in Helena’s lung, Dr. Owada used the inserted catheter to pull the pin out safely. The process took only 20 minutes, and Helena suffered no significant trauma.

New technique will help in future cases

“They saved our daughter’s lung,” says Brendan Phillips, Helena’s dad. “How can we ask for more than that?”

“It’s amazing what they were able to accomplish,” says Emily Phillips, Helena’s mom. “We’re very grateful. It could have been a much different outcome. But the doctors came up with a plan that worked.”

Aspiration and ingestion of foreign objects in children is common. In the United States, an estimated 2,000 deaths due to aspiration of foreign bodies occur a year. The majority are children, especially those ages 1 to 3 years. Common foods most responsible for aspiration deaths include hot dogs, candy, nuts and grapes.

Children’s pediatric specialists say the approach they used with Helena could be used in other cases. “In the future, I think we’ll be faster at pulling out things that children swallow,” says Dr. Owada. “We want all stories to have a positive ending.”