Coin Ingestion Research Articles

Numismedica II: Health Problems Caused by Coins.

Coins occasionally cause health problems. These problems have a wide range of presentations and can affect multiple organ systems. This article updates a 2009 review of the medical literature addressing health problems caused by coins in several ways. The spectrum of clinical findings is expanded by describing new entities associated with coin ingestion, including laryngeal impaction in adults, gastric perforation, and pancreatic disease. Guidelines for differentiating swallowed coins from the potentially life-threatening mimic of swallowed button batteries are summarized. Multiple new case series better define outcomes and management approaches in coin ingestion. Metal toxicity from coins remains rarely reported. The evidence that systemic allergic reactions can result from ingested coins is strengthened by new case reports. Maintaining the perspective that coin ingestion can cause obscure symptoms may lead to both a diagnosis of the cause of such symptoms and the description of clinical findings not yet reported.

A Retrospective Review of the Management of Impacted Coin Ingested in Children.

Accidental coin ingestion is a common presentation amongst paediatric patients in emergency departments (ED) worldwide, necessitating prompt management to prevent complications. This study aimed to describe the clinical features of paediatric patients with impacted oesophageal coins at Dr. George Mukhari Academic Hospital ED and compare outcomes between the balloon catheter and oesophagoscopic techniques for coin extraction. This was a retrospective review of the medical records of patients aged ≤12 years over 5 years. Data were collected from the hospital records and analysed using SAS® (SAS Institute Inc, Cary, NC), Release 9.3, running under Microsoft Windows. The analysis included 95 patients (51 females, 44 males) with a median age of 3 years, ranging from 0.70 to 10 years. Coins were predominantly located in the upper oesophagus (71.6%). Thirty-five (36%) children presented 8 h after the ingestion of the coin. At presentation, 82 (86.3%) patients were asymptomatic. The most observed symptoms were hypersalivation in 17 (17.9%) patients and vomiting in eight (8.4%) patients. Of the 62 patients for whom the balloon catheter was solely used, it was successful in 77.4% of the cases. Rigid oesophagoscopy was used in 33 patients as the first procedure (34.7%), and its overall success rate was 100% (44 patients). This study contributes valuable insights into the management of oesophageal coin ingestion in a resource-constrained setting, emphasising the safety and efficacy of the balloon catheter and the role of rigid oesophagoscopy in cases of failure or delayed presentation.

Consumer Trends Reflected in the Contents of the Pediatric Esophagus: A 20-Year Review.

To evaluate epidemiological trends of pediatric esophageal foreign body (EFB) ingestion over two decades. A retrospective analysis was performed using data from the National Electronic Injury Surveillance System (NEISS) database for children <18 years who presented to a United States Emergency Department (ED) with EFB between 2003 and 2022. Number of cases and type of EFB were recorded. Rates of EFBs over time were analyzed via linear regression. A total of 52,315 EFB cases were identified over the 20-year period, with a national estimate of 1,589,325 cases. The most frequently ingested objects were coins (37.6%), toys (13.5%), and batteries (6.8%). Overall incidence of EFB ingestion increased from 7.3 to 14.2/10,000 children from 2003 to 2022 (R2 = 0.8, p < 0.0001). Incidence of coin ingestion increased from 3 to 4.5/10,000 children (R2 = 0.06, p = 0.335) but represented a smaller proportion of all EFB over time (66% in 2003 versus 43% in 2022). Incidence of magnet, battery, and toy ingestion have increased from 0.3 to 1.0/10,000 (R2 = 0.9, p < 0.0001), 0.3 to 1/10,000 (R2 = 0.7, p < 0.0001), and 0.6 to 2.3/10,000 (R2 = 0.8, p < 0.0001) children, respectively, between 2003 and 2022. The proportion of magnet, battery, and toy ingestion have increased over time (3.2%, 6.5%, and 11.8%, respectively, in 2003 to 11.4%, 11.7%, and 22.2%, respectively, in 2022). Magnet, battery, and toy ingestion have increased significantly in the past two decades, while the proportion of coin ingestion has decreased. This trend may reflect shifts within the consumer market and increased availability of electronics concurrent with the adoption of digital currency. 4 Laryngoscope, 2024.

Stomach Foreign Body: A Retrospective Study with a Review

Foreign bodies in the stomach may be accidental or voluntary swallowing. Most foreign bodies are due to unintentional ingestion except in insane people or drug peddlers who may be voluntary. Most of the time, coins are accidentally ingested by children. A rare phenomenon is accidental ingestion of a size 16 to 20 cm in length (toothbrush) foreign body in a sane person. Oesophageal foreign bodies are not as risky as airway foreign bodies. These foreign bodies can obstruct and are located at the oesophagus cricopharynx constriction, the crossover of the aortic arch at the mid-oesophagus, and the lower end. After reaching the stomach, most ingested foreign bodies less than 6 cm will pass uneventfully through the gastrointestinal tract, as in 10 patients who consumed one/two rupee coins. Nevertheless, long and rigid foreign bodies like toothbrushes can result in gastrointestinal impaction, perforation and bleeding. Moreover, there have been a few case reports of spontaneous passage of a toothbrush, and promptly removing such ingested foreign objects is recommended before complications develop. Treatment option remains controversial considering the waiting policy or intervention, either endoscopic or surgical. This study describes 11 patients, 10 cases of coin ingestion and one case of the swallowed toothbrush. Ten cases of coin ingestion were managed conservatively. Upper midline laparotomy was done to remove the toothbrush as removal via flexible endoscopy failed. A swallowed toothbrush is a special clinical challenge. Early retrieval of the toothbrush is critical for reducing morbidity.

Double coin ingestion in a child: a rare occurrence

Foreign bodies in the esophagus pose a common ENT emergency, often involving a single coin that typically passes without harm. However, the occurrence of paired coin foreign bodies is exceptionally rare. A notable case involves a 3-year-old child who presented to the ENT emergency department with sudden dysphagia and vomiting. A plain X-ray of the soft tissue in the neck and chest revealed a unique finding-a double circular opacity in the cervical esophagus, indicating the ingestion of two foreign bodies in perfect radiological alignment. Given the rarity of such cases, coupled with the challenges in diagnosis when a comprehensive history is unavailable, this instance stands out. The child underwent a rigid esophagoscopy under general anesthesia to address the situation. This case underscores the importance of considering uncommon scenarios in clinical practice and the necessity for thorough diagnostic approaches, especially in the absence of a detailed patient history. The presentation of dual foreign bodies in precise radiological alignment adds a layer of complexity to the diagnosis, highlighting the need for a nuanced and vigilant approach in managing such infrequent but potentially serious cases in the ENT emergency setting.

Handheld metal detector versus conventional chest and abdominal plain radiography in children with suspected metallic foreign body ingestion: can we safely abandon X-rays?

Ingestion of metallic foreign bodies (MFBs) is a frequent occurrence in children and is commonly diagnosed via X-rays. In recent years, the handheld metal detector (HMD) has been increasingly adopted by several pediatric hospitals as it is considered an effective and accurate diagnostic tool that avoids exposure to ionizing radiations. Sensitivity of HMD has been reported high (99.4%) in case of coin ingestion, but significantly lower (46%) when considering the ingestion of other types of MFBs. We tested the effectiveness of the HMD in diagnosing ingested MFBs in children less than 14 years of age, in our Pediatric Emergency Department (PED). We prospectively evaluated all cases of MFBs ingestion that presented at the PED of our hospital from March 2015 to July 2017. Ninety-eight patients were included. The overall sensitivity was 63.2% (79.5% for coins, 25.5% for batteries and 56% for other objects) while the specificity was 95%. The HMD could have replaced the X-ray examination only if a MFB was detected below the xyphoid process. Based on our findings, a negative result of HMD is not sufficient to exclude an ingestion of MFBs. Therefore, in case of an evocative history and depending on type and size of the foreign body, a radiological investigation is still necessary.

RARE PRESENTATION OF NEGLECTED FOREIGN BODY NASOPHARYNX WITH PALATAL PERFORATION: CASE REPORT

INTRODUCTION Ingested foreign (FB) body to get lodged in the nasopharynx is a rare entity as the direction of mo v eme n t i s a g a i n s t g r a v i t y [ 1 ] . U p p e r aerodigestive tract may harbour foreign bodies due to accidental insertion, inhalation or ingestion. These objects may go undetected for days, weeks or months with minor or no symptoms. MATERIAL AND METHOD We report an unusual case of a nasopharyngeal foreign body in a 3 year old girl which was visualized through a perforation in the soft palate with a history of coin ingestion 6 months back, on X- ray it was confirmed to be in nasopharynx (Fig.1) and was removed immediately. CONCLUSION we come to the conclusion that examination of nasopharynx and radiological evaluation is necessary in cases of missing suspected foreign bodies in aero digestive tract. Immediate removal is indicated, because if ignored for long duration might lead to complications. Ke y w o r d s : n a s o p h a r y n x , f o r e i g n b o d y, aerodigestive tract.

Characteristics And Outcomes Of Aerodigestive Foreign Bodies In Children.

Aerodigestive foreign bodies are common in children of pre-school-going age. It is one of the leading cause of morbidity and mortality in the paediatric population and a global health burden. We present here data of 108 patients who presented to Children hospital's Emergency with a suspicion of foreign body ingestion/aspiration over 2 years from July 1st 2021 to 30th June 2023. Their descriptive analysis including, socio-demographics, type of foreign body, age of presentation, and mode of presentation were calculated and correlation was done using the Pearson Chi square test. We observed different types & characteristics of foreign bodies, patients were predominantly male with 62.26%. The mean age of presentation was 40.97 months. The majority of patients were of pre-school age, younger than 4 years (44.44%) followed by the infant population (19.44%) p=0.002. Foreign bodies were mainly located in the upper oesophagus for ingested FBs (60.8%). Most of the population presented within the first 5 hours (52.88%) followed by the first 12 hours (11.11%). Coin ingestion was by far the most common (54%) followed by button battery (19%) and the whistle was the most common aspirated object (33%). All patients with a suspicion of foreign body ingestion/inhalation should be evaluated. Early recognition and treatment are imperative because the complications are serious and can be life-threatening and once confirmed should undergo endoscopic removal.

Foreign Body Removal from Stomach: An Innovative Approach Using C-arm in ENT.

The ingestion of foreign body is a very common occurrence in pediatric age group. The retrieval is an emergency procedure performed mostly by the Otolaryngologist and Gastroenterologist. We present a case of coin ingestion who reported to a tertiary care center. It was retained in the lower part of esophagus as confirmed by imaging. Subsequently during the rigid esophagoscopy it was found missing from distal esophagus. A 9 year old female child presented with accidental ingestion of coin. The imaging done immediately prior to intervention confirmed position of coin in distal esophagus. However, up on visualization with rigid esophagoscope the coin was not found in esophagus and suspected to have passed in to stomach. We used C-arm to confirm the location which has its own limitations. There have been various case reports of using c-arm for tracing lost needles and broken instruments by oro-maxillo-facial surgeons. There are no reports where it has been used to aid foreign body removal fromgastro-intestinal tract. This is first case report where the use has been improvised due to lack of advanced facilities available at better and well equipped centers.The retrieval of foreign body from stomach aided by c-arm has not been reported in literature till now. The case report would add to the knowledge, options and practice at a center which does nothave any super speciality facilities.

Double Coin Mimicking a Button Battery: a Rare Radiological Entity of an Esophageal Foreign Body.

Ingestion of foreign bodies is a common entity in emergency clinical practice, especially in the pediatric population. Personal history is rather challenging in these patients, while it is important to accurately define the ingested foreign body. Therefore, the history of a caregiver/eyewitness, physical examination and radiographic findings are taken under consideration. Coins - in various places and alignments - are among the most common foreign bodies of the upper digestive tract, while a history or radiological findings of button batteries are indicating the need for immediate removal. We report a rare case of a seven-year-old boy with an esophageal foreign body, whose radiographic findings were intriguing, as they were suggesting a button battery digestion, while urgent esophagoscopy revealed a double coin ingestion perfectly aligned in the same place, opposing each other.

A Coin and Something Else: A Rare Case Report

Foreign body ingestion in children is considered an emergency. The most common ingested foreign bodies are coins; however, the ingestion of disc batteries is on the rise requiring urgent rigid esophagoscopy. In the literature, multiple foreign body ingestion is very rare and only a few cases of multiple coins and multiple battery ingestion have been reported in the past. Herein, a case of simultaneous coin and battery ingestion requiring foreign bodies removal on two sequential endoscopies due to improper initial evaluation in a pediatric patient is reported which, to our knowledge, is the first reported case.

S2461 A Dime in the Rough: Coin Ingestion Unveiling Crohn's Disease

S2461 A Dime in the Rough: Coin Ingestion Unveiling Crohn's Disease

A case of stacked coin ingestion mistaken for button battery

Button battery ingestion requires emergency endoscopic removal since severe complications, such as esophageal perforation, can develop within 4 hours of the ingestion. Given that guardians do not witness the children’s foreign body ingestion 40% of the time, physicians can only guess what was swallowed based on plain radiography. We report a case of a 45-month-old-boy who visited the emergency department after swallowing an unknown foreign body and whose radiographs showed “circle-within-a-circle appearance” on the anteroposterior view and “step-off appearance” on the lateral view, suggesting button battery ingestion. We conducted emergency endoscopic removal, and found stacked coins mimicking a button battery on the radiographs. The coins were pushed into the stomach and came out through defecation 3 weeks later without further complications. Distinguishing between stacked coins and a button battery through radiography may help avoid unnecessary emergency endoscopy.

Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries.

Coin-shaped button battery foreign bodies have a similar initial presentation to coin ingestion, but delayed retrieval of a battery from the esophagus can have devastating consequences. Variations in timing of retrieval for children with ingestion of coin foreign bodies have been reported. The study assesses the sensitivity and specificity of conventional and digital radiographs to differentiate button batteries from coin foreign bodies. 3B case control study. Tertiary academic medical center. A radiographic study of the 12 most common commercially available button batteries and 66 coins of varying international origins was performed. Foreign bodies were placed at the cervical esophagus of a cadaver, and anteroposterior (AP) and lateral conventional radiographs of the neck were obtained. Digital AP and lateral radiographs of standalone coins and batteries were also obtained. Images were blindly read by 2 otolaryngologists and 2 radiologists. Statistical analysis was performed to determine accuracy in identifying coins vs batteries. Using conventional radiographs to identify button batteries yielded a sensitivity of 0.88 and a specificity of 0.92 (positive predictive value [PPV] = 0.75, negative predictive value [NPV] = 0.97). Digital radiography yielded an overall sensitivity of 0.98 and specificity of 0.97 (PPV = 0.87, NPV = 0.99). Features of button batteries were only seen on AP conventional radiographs using reverse contrast. Neither conventional nor digital radiographic imaging had perfect accuracy in identifying coins vs batteries. Features of common disc batteries were identified, which may aid in diagnosis. With potential devastating consequences from retained battery in the esophagus, emergent removal of any possible disc battery foreign body should be considered.

S3543 Esophageal Parakeratosis? You GERD Be Kidding!

INTRODUCTION: Esophageal parakeratosis is an atypical finding on histology with limited data available. On microscopy it is characterized by superficial, compact squamous epithelium with retained pyknotic nuclei. References describe parakeratosis in various clinical settings such as candidiasis, vitamin B12 and zinc deficiencies, esophageal lichen planus and ethanol exposure in adults. To our knowledge, based on a PubMed Search, this condition has never been reported in children. We describe a child with esophageal parakeratosis with history of reflux symptoms and recent coin ingestion. CASE DESCRIPTION/METHODS: An 8-year-old boy with a history of regurgitation presented to the emergency room with dysphagia after swallowing a penny earlier that day. Chest X-ray revealed a discoid metallic foreign body lodged in the mid esophagus. During upper endoscopy the coin was located in the mid esophagus and retrieved easily. There was an erosion at the site of the penny lodgment and furrowing of the distal esophagus. Biopsies were obtained from the distal esophagus and mid esophagus, distal to the site of coin lodgment. On histological examination of the mid esophageal biopsies, there was mild reactive esophageal squamous mucosa with focal superficial erosion, focal parakeratosis, mild mixed inflammation and vascular congestion without evidence of eosinophilic esophagitis. Based on the pathology, he was diagnosed with gastroesophageal reflux disease (GERD) esophagitis. He was treated with a proton pump inhibitor for 3 months with clinical resolution of reflux symptoms. A 3-month follow-up endoscopy revealed mild edematous mucosa in the distal esophagus without furrowing, ulcers or erythema. Histopathology of the proximal and distal esophagus revealed persistence of minimal reactive esophageal mucosa, with vascular congestion and minimal chronic inflammation but with no parakeratosis. DISCUSSION: Esophageal parakeratosis is often a non-specific histological finding. Based on the clinical history, the resolution of esophageal parakeratosis on repeat biopsy in an area distal to the coin lodgment, along with subtle findings of esophagitis after PPI therapy, led us to believe that the parakeratosis was a manifestation of GERD. It is unlikely that these changes are secondary to a blunt foreign body (coin) reaction in such a short window of time. Clinicians should be aware that esophageal parakeratosis may be associated with GERD.

History and radiographic findings as predictors for esophageal coins versus button batteries

ObjectiveTo determine if clinical history and radiographic findings are reliable predictors for coin versus button battery in children presenting with esophageal foreign bodies to accurately guide decision making regarding the urgency of removal. MethodsA retrospective chart review was conducted in a single pediatric tertiary care center of all children who presented with suspected coin or button battery esophageal foreign body ingestion from 2017 to 2019. Patients with documented surgical removal, completed consultation notes, and available radiographic studies were included. Descriptive statistical analysis was performed and predictive characteristics of the diagnostic tests were calculated. Results139 patients met inclusion criteria for the study. Of 5 patients who had esophageal button batteries removed, clinical history was concerning for button battery in 2; accuracy of 12.35%. However, radiology reports suggested a battery in all 5. The negative predictive value for radiology alone for diagnosis of button battery was 97% with 81% accuracy. The clinical history for coin foreign body was accurate in 85.28% while radiography was 87% accurate. Wait time on average for all coin foreign body cases was 6.3 h. Day cases waited on average 5.5 h while after-hours cases waited a statistically significantly longer 7.5 h (p = 0.006). ConclusionButton batteries, while clinically important emergencies, are rare esophageal ingestions. Radiography has a strong negative predictive value for button battery. Children whose radiographic studies do not demonstrate concern for button battery could be considered for delayed elective removal. This could allow children to complete a period of observation at home, thereby reducing prolonged in-house wait times prior to operative removal.

Foreign body ingestion by children: an analysis of age and types at a tertiary hospital in Bangladesh

Foreign body (FB) ingestion is common in children worldwide. Type of FB ingestion varies among cultures and countries. We retrospectively reviewed all patients of foreign body ingestion who were admitted in Department of Pediatric Surgery, Chittagong Medical College Hospital from January 2017 to December 2019 (total 3 years). Age, Sex, type of foreign body, hospital stay, management and outcome were analyzed. A total of 91 children were admitted with ingestion of FB during this period; male 61, female 30 (male to female ratio 2:1). Age ranged from 3 months to 12 years (median 3.5 ± 3.8 years). Fifty eight percent were less than 5 years old. Children ingested 21 different types of FB; however ingestion of coin was most common (24 patients, 26.37%) followed by different types of pins (19 patients, 20.88%), nail (6 patients, 6.59%), battery (5 patients, 5.49%), screw (5 patients, 5.49%), needle (4 patients, 4.40%), ring (4 patients, 4.40%) and others (18 patients). Sharp object ingestion is higher in older (&gt;5 year) age group. Hospital stay ranged from 0 day to 19 days (mean 1.6 ± 2.1 day). Endoscopic removal needed in 4 patients (coin-2, chain 2), bronchoscopic removal in 1 (pin) and one patient needed laparotomy (open hair pin). There was no mortality. The pattern of FB ingestion is similar to many other countries. Small, smooth objects pass spontaneously. Endoscopic or surgical intervention is sometimes needed if significant symptoms develop or if the object fails to progress through the gastrointestinal tract.&#x0D; Asian J. Med. Biol. Res. June 2020, 6(2): 299-304

Evaluation of zinc and copper toxicity caused by ingestion of Turkish coins: An in vitro study

Evaluation of zinc and copper toxicity caused by ingestion of Turkish coins: An in vitro study

Accidental Ingestion of Foreign Bodies in Children: Experience from Developing Countries

Introduction: Accidental ingestion of foreign bodies in children is uncommon, regardless of whether in the developed or underdeveloped countries. Reports in the United States show that the most common object is a coin. The majority of the patients are asymptomatic. As the patients are asymptomatic, most of the patients were treated conservatively as the foreign bodies pass out spontaneously. In certain cases, an endoscopy is needed to retrieve the objects. This study illustrates the experience in managing the condition in a developing country. Methods: This is a retrospective study looking into the management of accidental foreign body ingestion in the local hospital. A computer search was made into the hospital database searching for a diagnosis of foreign body ingestion between April 2017 to May 2018. The parameters of the patients were retrieved from the computer database. Patients with incomplete data were excluded Result: 14 patients were identified with the diagnosis of ingested foreign bodies. One was excluded due to incomplete data. The patients' age ranges from 1 to 10 years old with 6/13 (46%) are 3 years or below. The most common objects ingested is coin (46%) followed by coin cell battery (23%). Only in one patient, the ingested material was radiolucent (stone) which was not seen on a radiograph. The majority (76.9%) of the ingested material passed out spontaneously except in 3/13 (23%), endoscopic retrieval of the material needed to be performed. There was no patient needed exploratory laparotomy. Conclusion: Accidental ingestion of coin is still the most common objects in children. Coin cell battery which is commonly used in an electronic device is getting more common. The majority of the objects can be visualized by radiograph and in the majority of cases, the material passed out spontaneously without any intervention.

Systematic analysis of button batteries’, euro coins’, and disk magnets’ radiographic characteristics and the implications for the differential diagnosis of round radiopaque foreign bodies in the esophagus

ObjectivesButton battery (BB) ingestion can cause life-threatening complications such as esophageal perforation, and mediastinitis. Chest radiography is the method of choice to diagnose BB ingestion. Therefore, an adequate interpretation of X-ray imaging by physicians is mandatory. The study aimed to analyze relevant diagnostic aspects of BB X-ray imaging, and retrospective analysis of the imaging of radiopaque foreign bodies. MethodsAll commercially available BBs and different foreign bodies such as euro coins (EC) and disk magnets (DM) were listed according to their sizes and compositions. Furthermore, an X-ray analysis of a test set of BBs, ECs and DMs was performed at angles of 0°, 45°, and 90°.Retrospective assessment of radiological characteristics was performed for patients with a round and radiopaque foreign body in the esophagus ResultsOnly BBs with a diameter of at least 20 mm had a reliable positive double rim sign at scan angles of 90°, and 45°. The step-off effect was visible in all BBs regardless of the diameter. DMs and ECs presented a homogeneous X-ray weakening at all investigated scan angles. In the retrospective analysis all five cases of BB ingestion showed a double rim sign, all fifteen cases of coin ingestion a homogeneous X-ray weakening. A corrugated margin was detected for 10 cent, 20 cent and 50 cent coins. ConclusionsBBs with a diameter of at least 20 mm showed, depending on the battery model, a more or less pronounced double rim sign and step-off effect in conventional X-ray imaging. However the double rim sign can be simulated by for example a pot magnet.