Cleveland Clinic Journal of MedicineThe Drop of a Pin: Accidental Ingestion of a Sharp Foreign Body

Navigating the Risks of Non-food Foreign Body Ingestion: A Clinical Insight into Detection and Management

This article presents a comprehensive case study of a 36-year-old female who accidentally ingested a tailor’s pin, providing a detailed examination of the clinical approach, diagnostic protocols, and management strategies in handling non-food foreign body ingestion. Through this incident, the article stresses the importance of timely intervention, appropriate imaging choices, and the nuanced decision-making process in endoscopic management, offering valuable insights for physicians navigating similar medical emergencies.

Key Points:

• A 36-year-old female inadvertently swallowed a tailor’s pin, presenting to the emergency department with mild sore throat and abdominal pain.
• Despite no significant medical history, her symptoms necessitated a thorough investigation to prevent potential complications associated with sharp foreign body ingestion.
• Initial physical and laboratory examinations were unremarkable, emphasizing the importance of imaging in detecting foreign bodies.
• Biplane radiographic imaging is preferred for initial assessment post-foreign body ingestion, aligning with American Society for Gastrointestinal Endoscopy guidelines.
• The patient’s radiographs revealed the pin in the left upper quadrant of the abdomen, indicating its location in the stomach without signs of perforation.
• Urgent endoscopy is recommended for sharp-pointed objects in the stomach or duodenum, but nonurgent endoscopy is suggested for non-pointed objects or those beyond the duodenum.
• After unsuccessful endoscopic retrieval, conservative management with serial abdominal radiography was employed, monitoring the pin’s progression.
• The patient eventually passed the pin naturally after 90 hours, avoiding surgical intervention and illustrating the effectiveness of conservative management in certain cases.
• The case emphasizes the necessity of individualized management plans based on the type, location, and progression of ingested foreign bodies.
• It highlights the critical role of timely and appropriate imaging and endoscopic intervention in managing ingested foreign bodies, potentially preventing severe complications.

According to a study published in Pediatrics, coins are the most commonly ingested foreign objects among children, accounting for about 61.7% of all cases.

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