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[Safe extraction of an impacted open safety pin from the esophagus: a new technique and five case studies]
Avishay Golz1, Arie Gordin, Aviram Netzer
1Department of Otolaryngology-Head and Neck Surgery, Rambam-Health Care Campus and The Bruce Rappaport Faculty of Medicine, The Technion, Haifa. golz@netvision.net.il
Insights
Ingested open safety pins in infants pose a rare but serious risk. A new endoscopic technique safely closes and removes these pins from the stomach, preventing esophageal injury.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Medical Device Technology
Background:
- Esophageal foreign bodies are common in young children, but open safety pins present a unique and severe risk.
- Improperly positioned safety pins can lead to esophageal perforation and life-threatening complications.
- Traditional removal methods may be challenging when the pin's sharp end is embedded in the esophageal mucosa.
Purpose of the Study:
- To describe a novel endoscopic technique for managing ingested open safety pins in infants.
- To demonstrate a safe method for closing and extracting embedded safety pins from the esophagus.
- To reduce the risk of complications associated with esophageal safety pin ingestion.
Main Methods:
- Review of pediatric cases involving safety pin ingestion between 1990 and 2003.
- Focus on five cases where open safety pins were embedded in the esophagus, with only the clasp visible.
- Implementation of a technique involving pushing the pin into the stomach, closing it endoscopically, and then extracting it.
Main Results:
- Nine out of fifteen infants presented with open safety pins in the esophagus; six had closed pins in the stomach/duodenum.
- The described endoscopic technique successfully closed and removed embedded safety pins in five infants.
- No mucosal or wall damage to the esophagus or stomach was observed following the novel removal procedure.
Conclusions:
- A flexible endoscopic approach can safely close and remove embedded esophageal safety pins in infants.
- This technique offers a viable alternative to minimize trauma and complications in specific pediatric foreign body cases.
- The described method provides a new, safe management strategy for this rare pediatric emergency.
Abstract:
Esophageal foreign bodies are common, especially in children less than 5 years old. However, the presence of an open safety pin in the esophagus is quite rare. When this occurs, immediate removal of the safety pin is recommended due to its propensity to pierce the esophagus and surrounding structures causing severe and sometimes even lethal complications. Between the years 1990 and 2003, fifteen infants were referred to the Department of Otolaryngology-Head and Neck Surgery at the Rambam Health Care Campus with a history of safety pin ingestion. Plain neck, chest and abdomen radiographs showed the presence of an open safety pin impacted in the esophagus and pointing upwards in nine of the cases, and in the remainder (six infants) a closed pin was demonstrated in the stomach or in the duodenum. This report focuses on five cases in which during esophagoscopy only the clasp of the safety pin was visible, whereas the sharp point was impossible to be grasped, as it seemed to be stuck in the mucosa of the esophagus. In these cases the pin was pushed into the stomach, where it was closed, and then it was pulled outside without any harm to the mucosa or the gastric and esophageal walls. We present a new technique on how to safely close an open safety pin in the stomach and remove it, without any complications, using a flexible endoscope.