Pediatr Gastroenterol Hepatol Nutr.  2019 Sep;22(5):441-446. 10.5223/pghn.2019.22.5.441.

A Case Series of Ingested Open Safety Pin Removal Using a Proposed Endoscopic Removal Technique Algorithm

• Demiroren

• KMID: 2457745
• DOI: http://doi.org/10.5223/pghn.2019.22.5.441

Abstract

PURPOSE
Safety pin ingestion is common in some regions of the world and may lead to severe morbidity and mortality. The aim of this study was to present some practical suggestions for ingested safety pins using an accompanying algorithm, presented for the first time in the literature to the best of our knowledge.
METHODS
Twenty children with ingested safety pins during a 4-year period were retrospectively included in the study.
RESULTS
Median age of patients was 9.5 months (interquartile range, 6.3-14 months), and 70% were girls. On endoscopic examination, safety pins were observed in the stomach (25%), duodenal bulb (20%), upper esophagus (15%), middle esophagus (10%), and second part of the duodenum (10%) but were not observed in 20% of the cases. Safety pins were removed using endoscopy in 15 cases (75%). In four cases (20%), no safety pin was observed on endoscopic examination. In one case (5%) involving a 6-month-old infant, the safety pin could not be removed although it was observed using endoscopy. No surgical intervention was needed for any patient. No complications such as perforation or deaths developed, except for erosions, due to the foreign body removal procedure.
CONCLUSION
Safety pins are easily removed endoscopically. The best option is to remove the safety pin using endoscopy while it is still in the esophagus and stomach. For this reason, endoscopic procedures should be performed as soon as possible in children who have ingested safety pins.

Keyword

Safety pin; Endoscopic, Foreign body; Algorithms

MeSH Terms

Child
Duodenum
Eating
Endoscopy
Esophagus
Female
Foreign Bodies
Humans
Infant
Mortality
Retrospective Studies
Stomach

Figure

• 

  Fig. 1 Examples of endoscopic images of ingested safety pins. (A) A safety pin with an attached blue bead and amulet in the esophagus. (B) A blue bead separated from a safety pin in the stomach. (C) A safety pin with its pin part penetrated totally in the antral mucosa and head part that had entered the duodenal bulb through the pylorus. (D) A safety pin that had penetrated the mucosa of the duodenal bulb.

• 

  Fig. 2 An algorithmic proposal for the technique of endoscopic removal for ingested safety pins.

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