Infants and toddlers will put just about anything into their mouths. Each year in this country, between 100,000 and 200,000 incidents of foreign-body ingestions are reported to poison control centers.1,2 The large majority of ingestions are accidental. (In adolescents, ingestions are usually intentional.)
The most commonly ingested objects are coins, toy parts, sharp objects, and batteries. Management depends on the object that has been ingested, its location, and the patient's age and size.
---- John Harrington, MD New York Medical College
These radiographs show a penny lodged in the upper to mid esophagus of a 13-month-old. Because the coin triggered drooling and pain, its removal was required.
When a foreign body is lodged in a patient's esophagus, prompt evaluation is indicated. Respiratory symptoms, esophageal erosions, and (rarely) esophageal-aortic fistulas with exsanguinations and death may be among the consequences.
Swallowed coins are usually found in the proximal esophagus at the region of the thoracic inlet; the middle esophagus, at the region of the carina; or the distal esophagus, proximal to the gastroesophageal junction.
Studies suggest that if an esophageal coin causes no symptoms, the patient may be observed for up to 16 hours1,2:
•If the ingestion occurred within the previous 24 hours.
•If there are no underlying esophageal or tracheal abnormalities.
Approximately 25% to 30% of coins pass into the stomach--particularly in older children and in those with a coin in the distal esophagus.
Endoscopic removal under general anesthesia with Magill forceps is the common treatment of choice when a coin remains lodged in the esophagus longer than 24 hours.
1. Soprano JV, Fleisher GR, Mandl KD. The spontaneous passage of esophageal coins in children. Arch Pediatr Adolesc Med. 1999;153:1073-1076.
2. Waltzman ML, Baskin M, Wypij D, et al. A randomized clinical trial of the management of esophageal coins in children. Pediatrics. 2005;116:614-619.
(Case and radiographs courtesy of John Harrington, MD, of New York Medical College and Maria Fareri Children's Hospital in Valhalla, NY.)