Is naso-pharyngeal swab always safe for SARS-CoV-2 testing? An unusual, accidental foreign body swallowing

Abstract

Long and sharp objects can be foreign body intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, localization in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms, or onset of complications. We present a case of a 47-year-old male with no known comorbidity, who accidentally swallowed a portion of a naso-pharyngeal swab half-broken during the second diagnostic test for SARS-CoV-2. The intact swab had a total length of 15 cm and was made of wood. The patient was asymptomatic, laboratory tests were normal, and neck-chest-abdominal X-ray and CT scan were negative for major complications. Upper gastrointestinal endoscopy was promptly performed to prevent the long sharp swab from crossing the pylorus leading to serious complications and, therefore, risk surgical intervention. The patient was intubated and the procedure was carried out under general anesthesia. In the gastric body, broken nasopharyngeal swab was detected among the food debris, and using a latex rubber hood, the 7.5 cm foreign body was removed with a retrieval alligator-tooth forceps. Our hospital is located in a high-risk area of COVID-19 outbreak where many nasopharyngeal swabs are performed, and to our knowledge, this is the first report of swab ingestion during SARS-CoV-2 test.

Role of the otolaryngologist in nasopharyngeal swab training: A case report and review of the literature

“…In a review of the literature regarding other major complications of nasopharyngeal swabs, there were at least 7 other instances in which the nasopharyngeal swab shaft broke within the nasal cavity of the patient, all of which required endoscopy for retrieval [ [21] , [22] , [23] , [24] , [25] ]. Three of these instances involved the shaft fragment inserting inferior to the inferior nasal turbinate, while two instances involved a fragment eventually being found in the gastric cavity [ [21] , [22] , [23] , 26 ]. In a study on 96 volunteers with both commercial swabs and 3D-printed swabs, the most common complications of commercial swab sampling included headache (5.2%), rhinorrhea (5.2%), and epistaxis (8.3%); however, one participant eventually had to be hospitalized for recurrent episodic bleeding after a commercial swab test [ 27 ].…”

Safety Precautions for Self-Performed Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Case of a Swallowed Swab

“…Nasopharyngeal (NPS) and oropharyngeal swabs (OPS) are the mainstays of sampling for either laboratory tests or point-of-care devices. Despite the significant number of tests performed, only few adverse events of swabbing have been reported [2][3][4][5][6][7][8][9][10][11]. Insertion of such applicators through natural orifices confers the possibility of foreign body retention with various consequences.…”

Sensitive detection and quantification of SARS-CoV-2 in saliva

“…Consistent with Centers for Disease Control (CDC) guidelines, most testing is currently performed by collecting upper respiratory specimens including nasopharyngeal (NP) and anterior nares nasal swabs (NS). Collection of upper respiratory swabs can cause complications in some patients [1][2][3][4] and is associated with discomfort, which reduces compliance.…”