Direct-Vision Removal of an Impacted Esophageal Padlock in a 7-year-Old at a Resource-Limited Facility: A Case Report.

Abstract

Background: Oesophageal foreign-body impaction is a frequent emergency that is typically managed with endoscopy. In resource-limited and remote health facilities, strict adherence to standard algorithms is impractical. Context-adapted clinical reasoning is sometimes critical for ensuring safe and timely management.

Case presentation: We report a case of a 7-year-old male child who presented to a remote health facility with acute dysphagia and odynophagia following accidental ingestion of a padlock confirmed on neck radiography. In the absence of endoscopic services, the padlock was successfully removed under direct laryngoscopy with Magill forceps under general anesthesia. The patient recovered uneventfully and was discharged 24 hours after observation.

Conclusion: This case highlights the importance of pragmatic clinical judgment and adaptive decision making in low-resource settings. When standard endoscopic services are unavailable, carefully selected alternative approaches can save life.