A 64-year-old man was admitted to the gastroenterology department after a nasopharyngeal swab broke inside his left nasal fossa during testing for SARS-CoV-2. The patient had no symptoms, and the physical examination was unremarkable.
The patient was examined by an otorhinolaryngologic physician. Nasofibroscopy was performed but did not detect the foreign body. Therefore, and considering that the swab had a sharp-pointed part (the broken swab’s extremity), EGD was performed. To perform EGD as soon as possible, the patient was considered to be SARS-CoV-2 positive, and adequate personal protective equipment was used: waterproof gown, 2 pairs of gloves, hairnet, goggles, shoe covers, and N95 respirator.
In the gastric cavity, the broken swab was visualized and seen to be approximately 6 cm long (A). The foreign body was retrieved with grasping forceps by the broken swab’s extremity, the cotton part being left free (B, C, D). The reassessment EGD did not show any lesions. The patient remained asymptomatic and was discharged.
To our knowledge, this is the first reported case of a broken nasopharyngeal swab retrieved from the gastric cavity by EGD. During the procedure, it is important to consider the use of grasping forceps in the broken extremity (sharp part) because the cotton part is blunt and smooth.
Disclosure
All authors disclosed no financial relationships.
Commentary This case illustrates the law of unintended consequences. This unfortunate individual underwent COVID-19 testing, and unfortunately the swab broke off and found its way to the stomach, where it required endoscopic retrieval. As foreign bodies in the GI tract go, this is a simple one to identify and remove.
This case raises several questions. First, what was the original indication for COVID-19 testing? Second, most units require a negative COVID test result before performing EGD. Did this patient require a second COVID-19 test before undergoing the EGD to retrieve the swab from the first COVID test? If so, I imagine there was a delicate conversation with the patient before he was retested. Third, what was the fate of the broken swab after removal? Was it sent to the laboratory for analysis for COVID status? Inquiring minds want to know. As many readers of this article have experienced firsthand, a COVID swab goes deeply into the nasopharynx, so you can easily see how a broken swab could end up in the stomach.
Douglas G. Adler, MD, FASGE, GIE Senior Associate Editor, University of Utah School of Medicine, Salt Lake City, Utah
Mohamed O. Othman, MD, Associate Editor for Focal Points
Mohamed O. Othman, MD, Associate Editor for Focal Points