Removal of open safety pins in infants by flexible endoscopy is effective and safe

In our country, safety pin ingestion by infants is commonplace. When swallowed, open safety pins are mostly found within the esophagus or stomach, and they cannot be easily removed by rigid esophagogastroscopy. Our aim was to evaluate the removal of safety pins using flexible endoscopy in infants.

We evaluated the cases of 7 infants who had ingested open safety pins between 2001 and 2004. In all the patients, the primary diagnostic tool was a direct x-ray of the neck, chest, and abdomen. In all cases, the safety pins were removed by flexible esophagogastroduo-denoscopy. Clinical records for the cases were reviewed.

Four of the open safety pins were lodged in the esophagus, two in the stomach, and one in the duodenum. One infant had a safety pin lodged in the esophagus with the pin's open end pointed caudally; the pin was held with the endoscopic forceps by its tail end and removed. Three safety pins in the esophagus had their open ends pointing cephalad; these were held by their tail ends using the endoscopic forceps and pushed into the stomach. Then they were rotated in the stomach and removed tail end first. The safety pins located in the stomach or duodenum were also removed similarly. All safety pins were successfully removed, and there were no operative complications.

Open surgery or other invasive removal methods are not necessary in infants with open safety pin ingestions. In our opinion, the best way to extract an open safety pin from the esophagus, stomach, or duodenum is by using a flexible endoscopic device.