An interdisciplinary approach to the endoscopic removal of a metallic nail from the esophagus of an infant

Objective: Exemplifying the value of an interdisciplinary approach between Otolaryngology and Gastroenterology in achieving safe removal of sharp foreign bodies from the upper aerodigestive tract. Methods: Case report with imaging. Results: We report the case of a 13-month-old boy who presented to the ER one day after ingestion of a metallic nail which was impacted in his cervical esophagus. Rigid esophagoscopy identified a curved metallic nail with one end easily visualized, and the other embedded in the esophageal wall. Significant resistance was met when using standard rigid endoscopic instruments to extract the object. It was only after insufflation was utilized from a flexible endoscope that the object was safely extracted, thus highlighting the need for a two team approach. Conclusion: In such cases where the shape and orientation of an object hinder removal, a multidisciplinary approach, in this case with our gastroenterology colleagues, can help to avoid injury to surrounding structures and/or mitigate the need for open surgical removal in the pediatric patient.