4yr old child swallowed a sewing needle accidentally. He is aymptomatic. The event occired 3 hours ago
No significant illness previously
No surgeries
What is the best option?
Esophagus –
If the object is in the esophagus, it should be removed immediately. Endoscopic retrieval of sharp objects is accomplished with use of retrieval forceps or polypectomy snare [ 90]. The risk of mucosal injury during retrieval of a sharp object can be minimized by orienting the object with the sharp end trailing during extraction and using a protector hood on the end of the endoscope or, in older children, an overtube [ 91,92]. Direct laryngoscopy is a reasonable alternative for objects lodged at or above the cricopharyngeus. (
Stomach or proximal duodenum – If the object is in the stomach or proximal duodenum, it also should be removed promptly using a flexible endoscope. The risk of a complication caused by a sharp-pointed object passing through the gastrointestinal tract is as high as 35 percent [ 93], although some case series describe lower complication rates from sharp objects (4 percent) [ 94,95].
Sharp objects that pass beyond the reach of a flexible endoscope and then cause symptoms will require surgical intervention. The most common sites of intestinal perforation are the ileocecal and rectosigmoid regions
Small intestine –
If the object has passed into the small intestine and the patient is asymptomatic, it may be followed with serial radiographs to document its passage.
Surgical intervention should be considered for objects that fail to progress for three consecutive days [4].
Urgent surgical intervention is indicated for patients with symptoms suggesting obstruction or perforation, which may include abdominal pain, vomiting, fever, hematemesis, or melena. Parents should be instructed to report any of these symptoms immediately.
Superintendent, ICH.