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A 15-year-old adolescent presented to the emergency department after accidentally swallowing a sharp metal object 4h before the visit. Apart from a single episode of non-blood-stained and non-bilious vomiting, he was asymptomatic. He appeared well-groomed, alert, and cooperative throughout the examination. His mood was stable, speech was clear and coherent, and he had no risk factors for suicidal ideation in his history. His clinical examination was unremarkable. An erect X-ray imaging of the abdomen showed a long, sharp, radio-opaque object crossing the midline at the L2 vertebral level (Fig. 1). Given the patient’s early presentation, asymptomatic status, and X-ray findings, the decision was made to proceed with upper gastrointestinal endoscopy instead of surgery. During the procedure, the metallic foreign body was found in the second part of the duodenum, near the ampulla of Vater. It was first delivered into the stomach using rat-tooth forceps, and to prevent mucosal damage during further extraction, an esophageal overtube was used for successful retrieval (Fig. 2). His recovery was uneventful, and he is doing well at the 1-month follow-up. Ingestion of a long or sharp object in an adolescent must raise suspicion of self-harm, the presence of psychiatric disorders, mental retardation, or involvement in a dare or misadventure. Accidental ingestions can occur when a foreign body placed between the lips gets sucked in following an unexpected cough, sneeze, or external distraction, similar to the hijab pin ingestions noted in adolescent girls [1]. After a confirmatory erect X-ray imaging, admission is necessary even if the child is asymptomatic, as the risk of perforation is 35% [2]. The longest documented sharp object to have spontaneously passed in a child was 4 cm long [3]. Objects >6 cm in size, at or above the level of the duodenum, mandate urgent endoscopic retrieval [4].