PMC7499273_01
Abdominal X-ray: arrow showing 3 metallic objects (screw, coin, and plastic head pin) in the stomach, and arrow head showing another plastic head pin well into the small intestine. Note that the small metal scrap that was later seen on endoscopy is not evident here.
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fig1
X-ray studies revealed at least 4 metallic objects in various parts of the GI tract (Figure 1).
A plastic transfusion pressure infusor. Note the missing rubber part used to construct the hood.
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fig2
Recognizing that complication rates could be high in this patient and that referral to another better equipped facility would require time, such that it would expose the patient to the risks of delayed intervention, we improvised a handmade rubber hood, constructed from a plastic transfusion pressure infusor (Figure 2).
(a) Rubber folded in coned fashion forming a bell-shaped hood and secured with silk tape. (b) Hood-inverted back on itself before scope insertion.
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fig3
The hood was fastened with silk tape to the distal end of a 9.8 mm gastroscope (GIF-Q165 Olympus Corporation, Tokyo, Japan), in a coned fashion (to facilitate the entrance of the foreign body into the bell of the hood), and then inverted (Figures 3(a) and 3(b)).
Testing if the foreign body fits in the hood before inserting the scope.
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fig4
A test was carried out before scope insertion to make sure that the foreign body fits in the hood (Figure 4).
Elongated pin and thick screw safely extracted. Note the bended tip of the pin which was impacted in the antrum wall.
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fig5
With the help of mild sedation (3 mg of midazolam), the pin and the screw were captured using rat-tooth forceps, pulled into the hood, and extracted (Figure 5).