Removal of sewing needle in upper oesophagus: An innovative role of Magill forceps.

Sir,

Magill forceps (MF) has been used in the past for removal of various foreign bodies like safety pins,[1] coins[2] and impacted piece of meat[3] in the oesophagus in children.

We had a very unusual situation in which we had a 16-year-old young healthy adult male (tailor by profession) who had accidentally swallowed a long sewing needle (the patient was holding the needle between his teeth when he had a sneeze). The patient presented to us in the emergency, with the needle lying in the upper oesophagus [Figure 1] with its thread hanging outside from the angle of the mouth [Figure 2]. Although the standard practice would be to remove it under direct vision using endoscopic guidance,[4] the emergency department of most of the set-ups, including ours, in this country, lacks such equipments and expertise. Therefore, we planned a novel idea of removing the needle under general anaesthesia using MF. MF is available even in the remote areas, and our age-old familiarity with this instrument makes it an easily available tool, which is comparatively safe under direct laryngoscopy requiring minimal expertise. The patient was pre-oxygenated for 3 min and induced with propofol 100 mg and 100 μg fentanyl and relaxed with 100 mg succinyl choline. We passed the free end of the thread through the hole of one of the jaws at the grasping end of the MF. The other jaw of the MF was left free. After laryngoscopy, we guided the MF into the oral cavity using the thread like a guide wire. We could not visualise the needle but continued gliding the MF gently along the thread into the oesophagus. The thread was being held under minimal traction by an assistant throughout the procedure. Once the MF hit the proximal end of the needle, we grasped the needle firmly between the two jaws of the MF and the needle was gently removed [Figure 3].

Figure 1

X-ray (AP view) showing sewing needle in the upper oesophagus (marked*)

Figure 2

Thread hanging from the angle of the mouth, which was used as a guide to reach the needle

Figure 3

Needle with thread after successful removal from the oesophagus

Although the MF has been used successfully for removal of various foreign bodies, especially those in the upper oesophagus, we made an innovative use of the hole present in the jaw at the grasping end of the MF. It also proves that the MF is safe and minimally invasive, especially under direct laryngoscopy, and has been preferred to rigid oesophagoscopy in the past.[1] Being a blind procedure, its greatest disadvantage is that the other end of such a sharp foreign body can traumatise the delicate and sensitive oesophageal wall, which can be minimised by performing the whole procedure under direct laryngoscopy and proper relaxation. Keeping in view the omnipresent and easy handling of MF, it can be said to be a valuable tool in the armamentarium for foreign body removal.