Coin Ingestion

Because as many as 35 percent of children with a coin lodged in their esophagus will be asymptomatic, some authors recommend that radiographs be performed on all children suspected of swallowing coins to determine the presence and location of the object. However, Caravati and colleagues 11 noted no difference in 5-day morbidity rates between children who underwent radiographic evaluation and those who did not after coin ingestion. Coins in the esophagus lie in the frontal plane with the flat side visible on an anteroposterior radiograph; coins in the trachea lie in the sagittal plane.

The use of a Foley catheter, initially reported in the late 1960s, has been promoted as a safe and effective technique for removal when the coin has been impacted for less than 24 h. Before attempting extraction, the airway must be secured with endotracheal intubation. The catheter is passed down the esophagus beyond the object and the balloon inflated. As the catheter is slowly withdrawn, the object is withdrawn along with it. Retrieval of a coin by this technique is less effective after 24 h. Most clinicians prefer using the Foley catheter under fluoroscopy. Foley catheter retrieval of foreign bodies may be complicated by aspiration, and personnel and equipment for airway control must be immediately available. If endoscopic expertise is readily available, Foley catheterization retrieval should be a secondary option.

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