28/10/2025
Gastric coin extraction in a child!! 😨 Coins are the most commonly ingested foreign body encountered in the pediatric population, especially those below 5 years of age. Coins that are lodged in the esophagus and are causing symptoms (cough, stridor, respiratory distress, drooling or pain) are managed with immediate removal via various methods, including endoscopy or with the use of Magill forceps (you’ve seen these on TV). Asymptomatic coins have been a perplexing problem to the clinician for decades, with some advocating for immediate removal while others are proponents of “watchful waiting”. Coins located in the proximal and middle esophagus have been thought unlikely to pass spontaneously. Thus, watchful waiting with an observation period has generally been implemented for distal esophageal coins only. Life-threatening complications of a delayed diagnosis include esophageal perforation, esophageal ulcer, peri-esophagitis, esophageal stenosis, tracheoesophageal fistula, mediastinitis, pneumothorax, pyothorax, unilateral vocal fold paralysis, and tracheal stenosis. The common signs and symptoms of esophageal foreign bodies retained for less than 24 h are pain, odynophagia, dysphagia, drooling of saliva, vomiting, gagging, anorexia, choking, and cyanosis. However, respiratory symptoms, such as cough, shortness of breath, stridor, upper respiratory tract infection, and pneumonia, are more consistent with the late (weeks to months) presentation of foreign body ingestion. Interestingly, children with a single esophageal coin seen within 24 hours of ingestion, who have no history of esophageal disease and no respiratory compromise on presentation, have a 1/3 chance of spontaneous passage of the coin to the stomach.
