Ingested Nasopharyngeal Swab for Viral Testing Retained in a Child’s Duodenum

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TL;DR

A 4-year-old boy accidentally ingested a 9 cm nasal swab during COVID-19 testing, which became lodged in the third portion of the duodenum and failed to pass spontaneously over four weeks. Endoscopic removal was successful without complications, despite initial expectation of spontaneous passage due to the swab's flexibility. This case highlights that nasal swabs with breakpoints, when ingested, may require endoscopic retrieval due to their length and risk of complications such as perforation.

Full summary

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**Background:** Foreign body ingestion in children is a common clinical problem, and objects longer than 6 cm are generally unlikely to pass spontaneously through the gastrointestinal tract. With the widespread use of nasal swab testing for COVID-19, including swabs designed with breakpoints in the handle, accidental ingestion during testing has become a recognized adverse event. This case report describes the ingestion and retention of a nasal swab in the duodenum of a young child.

**Methods:** This is a single case report of a 4-year-old boy who presented with fever and underwent COVID-19 testing via nasopharyngeal flock swab at a clinic. During the test, the child moved despite being held by his mother, causing the swab to break. Initial computed tomography (CT) showed the ingested swab in the stomach. Follow-up CT at 5 days demonstrated that the swab had advanced to the third portion of the duodenum. Spontaneous passage was initially expected due to the swab's flexibility. The patient was referred to hospital four weeks after the ingestion event. Upper gastrointestinal endoscopy was performed to assess and manage the retained foreign body.

**Key Results:** At the time of referral, the child had no gastrointestinal symptoms and no issues with food intake. Endoscopy revealed the 9 cm nasal swab still lodged in the same location (third portion of the duodenum) where it had been seen on CT at day 5. The surrounding mucosa showed mild redness but no ulceration. The swab was successfully removed endoscopically. The patient was discharged the following day without any complications. The removed swab was noted to be fractured at the breakpoint. The authors reference that nasal swabs can even perforate the sigmoid colon in adults, citing a prior report.

**Clinical Implications:** This case demonstrates that nasal swabs with breakpoints, when ingested accidentally, may not pass spontaneously even if they are flexible, because their length (9 cm in this case) exceeds the typical threshold of 6 cm for spontaneous passage. The authors recommend that if a nasal swab with a breakpoint is ingested, endoscopic removal should be attempted rather than waiting for spontaneous excretion. The case also underscores the importance of careful technique during COVID-19 testing in children to prevent such adverse events.