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Special Feature
November 2001

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Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

Arch Surg. 2001;136(11):1325-1326. doi:

If such a dreamy touch should fall, O turn thee round, resolve the doubt; My guardian angel will speak out In that high place, and tell thee all.—Alfred Lord Tennyson

A 13-MONTH-OLD boy was brought to the emergency department by his parents within 1 hour of an acute choking episode at home. He was suspected of having swallowed a small guardian angel pin now missing from his mother's clothing. The otherwise healthy child was crying, drooling, and appeared to be in mild discomfort. He demonstrated clear breath sounds bilaterally without wheezing or stridor. His oxygen saturation remained 98% on room air. Posteroanterior (Figure 1) and lateral radiographs were obtained.

What Is the Most Appropriate Management for This Patient?

A. Urgent endotracheal intubation in the emergency department

B. Retrieval of the foreign body using a Foley catheter with fluoroscopic guidance

C. Direct laryngoscopy, endotracheal intubation, and rigid esophagoscopy with foreign body removal in the operating room

D. Endoscopic removal of the object using intravenous sedation