The Case of a Missing COVID Swab : JPGN Reports

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The Case of a Missing COVID Swab

Watson, Ashleigh MD; Karam, Lina B. MD

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JPGN Reports 3(4):p e272, November 2022. | DOI: 10.1097/PG9.0000000000000272
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A 7-month-old previously healthy male presented to the emergency department with a 1-day history of cough, congestion, and fever. While in the emergency department, he was being swabbed for severe acute respiratory syndrome coronavirus 2 when the tip of the swab broke off in his nose (at the location intended to break off into the tube once swabbing is complete). At first, the tip of the swab was visualized inside the nare; however, it was not reachable. Forceps were then obtained, but at this point, the swab was no longer visualized. The child had not experienced any choking, gagging, or coughing, so its location remained unknown. Otolaryngology was consulted and performed a bedside flexible nasolaryngoscopy, which did not reveal the swab. Neck, chest, and abdominal x-rays as well as computerized tomography (CT) foreign body protocol were obtained, but the swab was not visualized. Within a few hours, the patient became fussy and inconsolable. Given concern for size (6 cm in length) as well as sharpness (pointed end of broken swab), esophagogastroduodenoscopy was performed and revealed the 6 cm tip of the swab in the stomach, traversing the pylorus into the duodenal bulb (Fig. 1A). The swab was carefully removed using rat tooth forceps to grab the sharp end (Fig. 1B, C). There was no damage to the mucosa of the esophagus, stomach, or duodenum.

Endoscopic images of COVID swab removal: (A) The tip of the COVID swab in the antrum traversing the pylorus into the duodenal bulb, (B) rat tooth forceps grabbing the sharp proximal end of the tip of the swab, (C) the tip of the swab now fully in the stomach as it is being removed.

This is the first case of accidental ingestion broken COVID-19 swab to be reports in pediatrics; there have been 2 similar case reports in adults older than 45 years of age (1,2).


A.W. and L.B.K. involved in substantial contributions to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


1. Medas R, Coelho R, Macedo G. An unusual collateral damage of COVID-19 pandemic. Gastrointest Endosc. 2020;92:1261–1262.
2. De Luca L, Maltoni S. Is naso-pharyngeal swab always safe for SARS-CoV-2 testing? An unusual, accidental foreign body swallowing. Clin J Gastroenterol. 2021;14:44–47.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.