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Esophageal foreign body - Coin ingestion, MedPix™ : 1175 - Medical Image Database and Atlas
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Location and Category

Location:
More Like This ? Gastrointestinal
Sublocation:
More Like This ? Esophagus
Category:
More Like This ? Trauma
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More Like This ? Esophageal foreign body - Coin ingestion
Topic 1175 - Created: 2001-02-12 16:10:02-05 - Modified: 2007-10-03 12:15:16-04
ACR Index: 71.461

Coins are the most common foreign body swallowed by children younger than five years old. Initial clinical manifestations may include cough, drooling, choking, pain, dysphagia, and occasionally dyspnea and stridor (secondary to compression of the trachea). Pain, fever, and shock are suggestive of esophageal perforation. Esophageal foreign bodies are associated with a number of complications, including lacerations, perforations, impaction, and irritation following removal. Symptomatic patients should be treated by endoscopy both to remove the object and to examine the esophagus for mucosal injury. Alternative measures include observation for 24 hours with the expectation that the coin will pass, or a foley catheter may be passed distal to the coin, the balloon inflated, and coin removed with the catheter.

Findings that allow localization of the coin to the esophagus are:

1. Coronal orientation of coin on PA film. If the coin were in the trachea, one would expect a sagittal orientation because the incomplete cartilaginous rings of the trachea open posteriorly.

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2. Lack of evidence of air trapping or obstruction (atelectasis, pneumonia, mediastinal shift).

3. Lack of clinical signs of airway compromise(cough, wheeze, respiratory distress).

4. Location of a relatively large object below the level of the larynx.

Two frontal views of the chest show a round metal object in the midline at the thoracic inlet. A lateral view shows the object behind the trachea, confirming the object is in the esophagus.

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Treatment of Esophageal Coins:
Endoscopic removal vs. Observation for spontaneous passage into stomach. Spontaneous passage occurs in 25-30%.

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Gastrointestinal Foreign Bodies:
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Contributor Credits

Topic Submitted by: Paul J Cunningham - Author Info
Affiliation: Madigan Army Medical Center
Topic approved by: James G. Smirniotopoulos, M.D. - Editor Info
Affiliation: Uniformed Services University

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