- Chest radiography is recommended
children who have swallowed coins
- In the esophagus, the flat surface of the coin will be seen on the
anteroposterior view, and the edge will be seen on the lateral view.
- The opposite will be true for coins present in the trachea
- The presence of a coin in the
stomach allows for expectant
observation in the absence of abdominal pain and vomiting.
- The absence of a coin on abdominal radiography that includes the esophagus
suggests that the history of ingestion was in error.
- Approximately 20% of coins become lodged in the esophagus and require
further intervention (endoscopic removal)
- Coins may become lodged at
the level of the cricopharyngeus muscle, aortic arch, and above the lower
- Approximately 75% of coins that do not pass into the stomach are lodged in
the proximal esophagus.
- Children who become symptomatic are at increased risk for having the coin
remain in the esophagus.
- Common presenting symptoms in young children include drooling, choking,
and poor feeding.
- The child may complain of throat or chest pain.
- Rarely, dyspnea and stridor develop as a result of extrinsic compression
of the trachea or larynx.
- As many as 44% of children may be asymptomatic despite the presence of a
coin in the esophagus.
- Serious complications following a coin ingestion are related to prolonged
- The change in composition of
pennies from copper to zinc
in recent years has increased the
potential for gastric mucosal corrosion.
- All coins that are lodged in the
proximal esophagus should be removed
as soon as possible.
- Patients who have coins in the
mid- to lower esophagus may be
observed for 12 to 24 hours if asymptomatic, but should undergo
endoscopy if the coin fails to pass in that time period.
- Complications of a coin lodged in
the esophagus for greater than 24 hours include
- esophageal perforation
- TE fistula
- esophagoaortic fistula
- Glucagon, which lowers pressure in the lower esophagus, has been used to
facilitate the passage of a lower esophageal foreign body in adults. Its
use has not been evaluated critically in children.
- Because a significant number of children who have a coin lodged in the
esophagus are asymptomatic and are at risk for mucosal erosion,
expectant observation and inspection
of the stool for the coin (which may take 3 to 4 days to pass) are
- The use of emergent endoscopy without confirming the presence and level of
the foreign body will result in a significant number of children being brought
to the operating room unnecessarily.
In anticipation of the possible need
for general anesthesia for foreign body removal, children should not be given
liquids to drink.
Caravari EM, Bennett DL, McElwee NE. Pediatric coin ingestion: a
prospective study on the utility of routine roentgenograms. Am J Dis
Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and
spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med.
Macpherson RI, Hill JG, Othersen HB, Tagge EP, Smith CD. Esophageal
foreign bodies in children: diagnosis, treatment, and complications.
AJR Am J Roentgenol. 1996;166:919-924