Coin Ingestion Research Articles

A retrospective clinical study and management of ingested Indian currency coin found in the oesophagus among paediatric age group

<p class="abstract"><strong>Background:</strong> Foreign body ingestion is a common event in children and carries significant morbidity and mortality. Indian currency coins are found to be the common ingested foreign bodies hence, to be treated accordingly.</p><p class="abstract"><strong>Methods:</strong> A 7 years retrospective review of 133 children diagnosed, admitted and managed for “ingested Indian currency coin” between January 2011 to December 2017 in the Department of Oto-rhino-laryngology and Head and Neck surgery, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka, India. A plain radiograph of the relevant views of neck and chest were taken to identify the foreign body. </p><p class="abstract"><strong>Results:</strong> There were 80 (60.2%) males and 53 (39.8%) females, ranging in age from 6 months to 15 years. Most of the patients 98 (73.7%) presented within 12 hours of the coin ingestion. 109 patients presented with one or more symptoms, common being vomiting 83 (62.4%). Coin was located mostly at the cricopharynx 111 (83.5%). Coin removal was possible using Macintosh laryngoscope and Magill’s forceps in 106 (79.7%) patients, and 27 (20.3%) patient’s required rigid oesophagoscope.</p><p class="abstract"><strong>Conclusions:</strong> Indian currency coin ingestion is commonly found in cricopharyngeal area of the oesophagus among preschool age group. The duration of retention of the foreign body, procedural time, hospital stay of the patient, diameter of the coin in both the genders have no impact on clinical outcome on retrieval of them.</p>

Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis

ObjectivesGiven the potential for devastating complications associated with esophageal impaction of a button battery, there is a need to distinguish between a button battery and look-alike stacked coins at the time of presentation. Given there have been no studies analyzing differences in radiographic density between these two entities, the study objective was to determine if a difference exists between esophageal coin and button battery radiographic density on plain radiograph and to describe the operative and treatment course following these two distinct entities of ingestion. MethodsRetrospective case series following button battery or stacked coin ingestion in a tertiary care pediatric hospital from 2003 to present. Radiographic density of each button battery and stacked coin was calculated by dividing the foreign body radiographic density by the mean density of two background radiographic sections. Radiographic density of coins versus batteries was compared using t-tests. ResultsThere were 22 patients identified with button battery ingestion and 47 with stacked coins. Median (range) radiographic density of button batteries on anteroposterior view was 1.16 (0.37–2.19) x background compared to 1.13 (0.09–2.65) x background of stacked coins, p = 0.198. There was similarly no statistically significant difference in lateral views, p = 0.622. ConclusionOur study suggests that radiographic density measured on diagnostic x-ray does not prove a reliable adjunctive measure to distinguish an innocuous stacked coin ingestion from the far more ominous button battery and highlights the need for prompt operative evaluation for any suspected button battery ingestion.

Which coin is easier to pass esophagus spontaneously?

ObjectiveTo determine the factors associated with the spontaneous passage (SP) of coins lodged in the esophagus in children. Subjects and MethodsA total of 351 pediatric patients with coin ingestion admitted to our hospital from March 2016 to March 2019 were included in the study. The patients underwent a period of overnight watch with a repeated chest x-ray within 24 h after the commencement of hospitalization. The influencing factors (sex, age, types of coin, time in the esophagus, and location) were analyzed. ResultsThe repeated chest x-ray showed coins that had passed into the stomach or intestine in 68 patients. Sex, age, time in the esophagus, location in the esophagus or the types of coins were not associated with SP, but the distribution of the esophageal coins varied statistically significantly in the different ages. ConclusionCoins pass spontaneously through the esophagus (19.4%) within 24 h, unrelated to sex, age, time of esophagus lodging, coin location in the esophagus, or coin types. Children approximately two years old were more likely to ingest small coins (10 or 50 cents), whereas children approximately five years old were more likely to ingest a large coin (1 Yuan).

Prolonged esophageal foreign body: Management strategies in the setting of complicated tracheoesophageal fistula

Abstract Esophageal coins rarely migrate extraluminally or cause systemic illness and the development of tracheoesophageal fistulae (TEF) secondary to coin ingestion is rare. When they do occur, surgical repair may be complicated by a contaminated operative site and systemic instability. As a means to review treatment options in this setting, we present a rare case of a 16-year-old female with a history of longstanding esophageal foreign body complicated by a large tracheoesophageal fistula, mediastinitis, and sepsis. She was ultimately managed by means of endoscopic diversion and tracheal stenting to reduce wound contamination in preparation for definitive open repair. A comprehensive literature review is performed and our approach to this patient's management is discussed. In the setting of a mediastinal leak, infection and systemic instability, endoscopic techniques and novel clip applicators may be employed to control wound contamination prior to definitive repair.

Coin, Earring, and Battery Ingestions

Coin, Earring, and Battery Ingestions

Foreign Body injuries in children in India: Recommendations for prevention from a comparative analysis with international experience

ObjectivesThis study aims to identify specific patterns of risk in order to contribute to the prevention of Foreign Body (FB) injuries by assessing FB injury characteristics in Indian children. MethodsSingle center case series are included in the worldwide registry on Foreign Bodies Injuries www.susysafe.org. Statistical analysis performed on FB injury data (age, medical information, FB anatomical location (ICD) and characteristics, and situational data) from 252 Indian children (0–14 years) was used to identify FB risk patterns. ResultsThe study included 252 FB injury cases, out of which 110 occurred in females (43.7%). Most of the reported FB injuries (N = 252) were located in the mouth, esophagus and stomach, or intestines and colon (34.5%), and in the nose (31.3%). The analysis of the median duration of all injuries (i.e., the difference between the reported injury time/date and the reported time/date of arrival at hospital) showed that children with a FB in the airways were those referred to the hospital latest (median of 332.50 min, p-value <0.001). With regards to FB type, the majority of FB objects were non-food items and ingestion of coins accounted for 25% of all FB injuries. ConclusionsCultural differences may exist with regards to the Indian diet being conducive to lower choking food risk for children, and to acceptability and accessibility to objects such as coins and stationery. Such findings should be taken into account when developing primary and secondary prevention strategies aimed at reducing the burden of such injuries in India.

An unexpected surprise: Delayed gastric outlet obstruction from coin ingestion.

Gastric outlet obstruction (GOO) is characterized by postprandial vomiting due to mechanical obstruction. Rarely it can occur due to ingestion of a foreign body. Most cases of foreign body ingestion are benign, with passage of the ingested object into the stool with no clinical sequelae. We describe a case of an 80-year-old woman with GOO occurring secondary to ingestion of two coins (American quarters). Rarely will such a small object cause a true gastric outlet obstruction. To our knowledge this makes the second such case reported in the medical literature.

Foreign bodies in esophagus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The presence of a foreign body in the esophagus is a challenging problem. Perforations may result in death. Impaction mandates immediate extraction.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective chart review was made of all patients hospitalized in Department of ENT, SMGS Hospital with a diagnosis of foreign bodies in the gastrointestinal tract between July 2017 to February 2018. Forty patients were identified. The charts were reviewed for the following: patient demographics, preoperative diagnosis, kind and location of the foreign body, timing of the procedure and the length of hospitalization. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The youngest patient in our study was 8 months old while the oldest was 60 years old. The male: female ratio of 2.3:1. The most common site of impaction was cricopharynx (55%) followed by thoracic esophagus (40%) and lower end of esophagus (5%). The most common foreign body was coin (50%) and all were seen in children upto 7 years of age. 25 (62.5%) patients were children of age less than 10 years. 20 children showed coin ingestion, 1 child of 8 months presented with impaction of fruit seed and 4 children with battery button ingestion. The length of retention of foreign body ranged from 2 hours to 6 days. All the patients were managed with rigid esophagoscopy under general anesthesia all within 12 hours of admission.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Rigid endoscope as the instrument of choice for extracting foreign bodies from the esophagus as delay in extracting foreign bodies from the esophagus may lead to retention of foreign body and hence perforation.&lt;/p&gt;

An extracellular histidine-containing motif in the zinc transporter ZIP4 plays a role in zinc sensing and zinc-induced endocytosis in mammalian cells

Zinc is an essential trace element that serves as a cofactor for enzymes in critical biochemical processes and also plays a structural role in numerous proteins. Zinc transporter ZIP4 (ZIP4) is a zinc importer required for dietary zinc uptake in the intestine and other cell types. Studies in cultured cells have reported that zinc stimulates the endocytosis of plasma membrane-localized ZIP4 protein, resulting in reduced cellular zinc uptake. Thus, zinc-regulated trafficking of ZIP4 is a key means for regulating cellular zinc homeostasis, but the underlying mechanisms are not well understood. In this study, we used mutational analysis, immunoblotting, HEK293 cells, and immunofluorescence microscopy to identify a histidine-containing motif (398HTH) in the first extracellular loop that is required for high sensitivity to low zinc concentrations in a zinc-induced endocytic response of mouse ZIP4 (mZIP4). Moreover, using synthetic peptides with selective substitutions and truncated mZIP4 variants, we provide evidence that histidine residues in this motif coordinate a zinc ion in mZIP4 homodimers at the plasma membrane. These findings suggest that 398HTH is an important zinc-sensing motif for eliciting high-affinity zinc-stimulated endocytosis of mZIP4 and provide insight into cellular mechanisms for regulating cellular zinc homeostasis in mammalian cells.

Chest Radiograph Alone Is Sufficient as the Foreign Body Survey for Children Presenting With Coin Ingestion.

Radiographic survey of the entire aerodigestive tract (nares to anus) is common practice in children presenting to the emergency department following coin ingestion. The purpose of our study was to determine the optimal protocol for radiographic survey post-coin ingestion. We hypothesized that for children presenting with a clear history of coin ingestion a frontal chest radiograph including the entire esophagus is adequate to guide treatment. We reviewed the clinical history and radiographic surveys of 134 patients presenting with suspected or witnessed coin ingestion to the emergency department of a tertiary care pediatric hospital between January 2012 and June 2016. Patient demographics, presenting symptoms, anatomic coverage of survey, type, number and location of radiopaque foreign bodies, intervention, and follow-up were recorded. Coins were identified on radiographic surveys in 109 of 134 patients; 25 of 134 patients had no coin. Of those with coins, none of 109 had coin(s) in the airway, 42 of 109 had coin(s) in the esophagus, and 67 of 109 had coin(s) distal to the esophagus. Of those with esophageal coins, 35 of 42 reported symptoms, 7 of 42 were asymptomatic, 40 of 42 underwent endoscopic coin removal, and 2 of 42 had no intervention. Of 92 of 134 surveyed patients with no coin or coin distal to the esophagus, 30 of 92 reported symptoms, 62 of 92 were asymptomatic, 90 of 92 had no further intervention, and 2 of 92 eventually underwent endoscopic coin removal for specific indications (abdominal pain, delayed passage). When there was no coin found in the esophagus, the negative predictive value for intervention was 97.8%. Following a clear history of coin ingestion, a frontal chest radiograph including the entire length of the esophagus provides sufficient information to direct patient management.

Spontaneous Passage of Ingested Coin in Children

Objective: To determine the factors related to spontaneous passage of ingested coins in children.&#x0D; Methods:&#x0D; Study Design: Retrospective Study&#x0D; Setting: Tertiary Government Hospital&#x0D; Subjects: The records of 136 pediatric patients with a history of coin ingestion seen at the emergency room department of our institution between December 2012 and May 2014 were retrospectively reviewed. Demographic data such as age and gender of the patient were recorded, including the type of coin, location of coin in the esophagus, time of ingestion and time of spontaneous passage into the stomach (for those that passed spontaneously).&#x0D; Results: Spontaneous passage in 27 out of 136 pediatric patients with radiographic evidence of a round radio-opaque foreign body initially located in the esophagus eventually passed into the stomach or intestines, accounting for 20% of the total number of cases. Coin ingestion was more common in patients aged 5 to 6 years (33% of cases), with slight male predominance (58%). One peso coins were the most common type of coin ingested, however only 24% of these spontaneously passed. The rate of spontaneous passage was highest in smaller sized coins (5 and 25 centavo coin) compared to larger sized coins (5 peso). Proximally located coins, albeit more common than middle and distally located coins, were the least likely to spontaneously pass (12%). Average time interval from ingestion to passage of the coin was 12 hours.&#x0D; Conclusion: Many factors are related to spontaneous passage of foreign bodies in the esophagus. The age of the patient, type of coin ingested, and initial location of the coin in the esophagus should be considered. Older patients, smaller sized coins, and distally located coins have the highest probability of spontaneous passage beyond the esophagus. A 12-hour observation period may be considered in patients with single esophageal coin ingestion.&#x0D; Keywords: foreign body, esophagus, esophagoscopy

Delayed Gastric Outlet Obstruction From Ingestion of Coins

Delayed Gastric Outlet Obstruction From Ingestion of Coins

Predictive factors associated with spontaneous passage of coins: A ten-year analysis of paediatric coin ingestion in Australia

ObjectivesCoins are the commonest foreign body ingested in paediatric populations. Although most ingested coins are either spontaneously passed or retrieved with medical intervention without serious consequence, there is potential for serious morbidity and mortality related to paediatric coin ingestion. We performed a 10-year retrospective review of Australian denomination coin ingestion at a tertiary paediatric hospital in Sydney, Australia. We attempted to determine whether a relationship exists between coin size, patient age, coin ingestion and spontaneous passage. MethodsHospital records of all children presenting in a 10-year period to a paediatric tertiary care centre for coin ingestion were reviewed. Demographic information, coin denomination, previous history, symptoms, investigations, management, outcome and complications were recorded. Results241 cases were identified. The majority (55%) of cases occurred in children ≤3 years of age (range 7 months–11 years, mean 3.39 years). The most common location where coins were identified was in the proximal third of the oesophagus or at the cricopharyngeus (65%). Spontaneous passage occurred in 84 cases (34.9%) while 167 cases (69.3%) required intervention. Children ≤3 years were more likely to ingest small coins (<22 mm) (OR: 2.44; 1.39–4.17) and children >3 years were more likely to ingest larger coins (22–26 mm) (OR: 2.17; 1.39–4.35). ConclusionsCoin size, coin weight and age of the child appear to be predictors for both likelihood of ingestion and spontaneous passage in paediatric coin ingestion cases. A child with minimal symptoms, witnessed ingestion and radiographic identification of the coin in the lower oesophagus or more distal can often be safety observed for up to 24 h in anticipation of spontaneous passage.

Utilization of a handheld metal detector protocol to reduce radiation exposure in pediatric patients with esophageal coins

ObjectiveThe primary objective of this study is to assess the utility of a handheld metal detector for identification and surveillance of patients with known esophageal coin ingestion to reduce repeat x-rays and associated radiation exposure. MethodsProspective study of children presented to the emergency department with esophageal coins confirmed by an initial x-ray were enrolled. The otolaryngology team used the handheld metal detector to detect and localize the coin on patient. If admitted for observation, the metal detector was used to ensure coin persistence prior to going to operating room for removal. No further x-rays were done if same location is confirmed. ResultsA total of 19 patients (10 months-14 years) with 20 esophageal coins were enrolled. 14 patients (73.7%) were initially detected in the emergency department by the metal detector. 11 (58%) asymptomatic patients admitted for period of observation, repeat x-rays were avoided in 10 (90.9%) patients prior to removal in the OR. All proximal esophageal coins were detected with the metal detector. There were 5 (26.3%) patients who failed initial detection of coin, and all of these were in the mid-distal esophageal location with depth from skin >7 cm. ConclusionA handheld metal detector is rapid, cost-effective surveillance tool to reduce exposure to radiation from repeated x-rays in patients with esophageal coins. In contrast to all prior published studies, which did not objectively examine depth, the distance of the coin from skin surface appears to be a major limitation. Parents have provided positive feedback on the protocol.

Small Bowel Obstruction in Ileal J-pouch From Coin Ingestion

Introduction Small bowel obstruction is a common complication after ileal J-pouch-anal anastomosis (IPAA). Adhesions are the most frequent cause. Foreign body ingestions are uncommon in adults. We report a rare case of a small bowel obstruction in an adult patient with IPAA after coin ingestion. Case Description A 72 year old man with history of refractory ulcerative colitis underwent protocolectomy with ileal J-pouch-anal anastomosis in 1999. He presented to the emergency department in December 2016 with complaint of crampy, lower abdominal pain, nausea and vomiting for two days. He denied any fever or chills. No constipation or diarrhea. Lab studies revealed a normal white blood cell count, normal lipase and normal liver function tests. CT scan of the abdomen revealed a dilatation of the distal ileum measuring 38 mm in diameter, small bowel wall thickening and mesenteric fat stranding proximal to the ilioanal anastomosis. Findings were concerning for small bowel obstruction with transition point at the ilioanal anastomosis. Patient underwent pouchoscopy which revealed erythematous mucosa in the j-pouch and presence of a severe stricture measuring about one cm in length and 7mm in diameter (Figure 1). The stricture was traversed after balloon dilation under fluoroscopic guidance (Figure 2). A United States penny coin was found proximal to the stricture which was retrieved from the j-pouch using a Roth Net® retriever (Figure 3). Patient had resolution of his symptoms after the procedure. Patient might have inadvertently swallowed the coin along with his daily pills which he routinely kept in his pants pocket. Discussion Coin and other foreign body ingestions are common in pediatric population but infrequent in adults. Swallowed items that pass beyond the pylorus are simply observed as they usually pass spontaneously through the gastrointestinal tract. Retained foreign bodies can increase the risk of complications by 50%, including formation of strictures, fistulas, abscesses, perforation, sepsis and death. It is estimated that up to 35% patients with IPAA experience small bowel obstruction most commonly due to extensive adhesions. It is possible that the high zinc content in the penny coin might have contributed to the inflammation and stricture formation in the j-pouch. Our case illustrates that retained foreign bodies can be safely and successfully removed endoscopically in patients with IPAA without need for open surgery.Figure: Balloon Stricture Dilation.Figure: Pre and Post Stricture Dilation.Figure: Coin in proximal J-pouch.

Surgical outcome of impacted artificial denture in esophagus

Introduction and objective Foreign body getting lodged in esophagus is quite common, commonly due to ingestion of coin, pin, fish bone and meat. But accidental ingestion of artificial denture is a less often found condition. This paper studies the etiology, management, complications and final outcome of denture obstructing the esophagus.

Emergency department consultations due to foreign body ingestion

Abstract Introduction Foreign body (FB) ingestion is an uncommon reason for going to the Paediatric Emergency Department (PED). The aim of this study was to assess the clinical and epidemiological characteristics of foreign body ingestion and the management of these patients. Patients and methods Retrospective study, including children under 14 years old with suspected foreign body ingestion seen in the PED between 2010 and 2013. An analysis was made of the circumstances of the FB ingestion, its management in the PED, and patient outcomes. Results Of the 226.666 presentations recorded, 1.608 (0.7%) were for a FB, 970 corresponding to ingestion of mainly fish bones (367, 38.7%) and coins (181, 18.7%), except in children under 1 year (plastic objects). The median age was 4.7 years, with boys being more common in those older than 4 years (58.5%). A total of 557 patients (57.3%) reported some symptom, and complementary tests were performed in 414 (42.7%). Another specialist was called in 315 (32.4%) cases, mainly from Ear, Nose and Throat (fish bones) or Surgery (coins). The FB was removed in 305 (31.4%) cases, which were mostly fish bones or sunflower seeds. Seventy-one patients (7.3%) were admitted, especially ingestion of fish bones or coins. No patient died. Discussion Ingestion of fish bones or coins by young children is a relatively common presentation in the PED, and it is associated with frequent medical interventions. Although the overall prognosis is good, improving the health education of the population should be considered to reduce the frequency of these episodes.

Foreign Bodies in Upper Gastrointestinal Tract: A Retrospective Analysis of Clinical Intervention and Management

Background: Ingestion of foreign bodies in to the gastrointestinal tract are not uncommon and incidence of airway intrusion and oesophageal obstruction by foreign body may increase the risk factor for morbidity and mortality. Material and Methodology: A retrospective study was done for 60 patients, admitted in the department of ENT of Hi-Tech medical college & Hospital, Bhubaneswar during 2014-15. Result and Observation: Children of 2-10 years age groups were reportedly more victimized (61%). The major incidences were attributed to coin ingestion (56%) followed by fish spine (25%), meat bone (11%) and safety pin (5%), other tablet cover. FB impaction was as high as 75% at cricopharnyx and 11% at oropharynx. The patients were managed without any surgical invasion. FBs were retrieved by Magill’s forceps with laryngoscopy and flexible oesophagoscopy intervention. No morbidity and mortality was occurred.

Consultas relacionadas con la ingesta de un cuerpo extraño en Urgencias

IntroductionForeign body (FB) ingestion is an uncommon reason for going to the Paediatric Emergency Department (PED). The aim of this study was to assess the clinical and epidemiological characteristics of foreign body ingestion and the management of these patients. Patients and methodsRetrospective study, including children under 14 years old with suspected foreign body ingestion seen in the PED between 2010 and 2013. An analysis was made of the circumstances of the FB ingestion, its management in the PED, and patient outcomes. ResultsOf the 226,666 presentations recorded, 1,608 (0.7%) were for a FB, 970 corresponding to ingestion of mainly fish bones (367, 38.7%) and coins (181, 18.7%), except in children under 1 year (plastic objects). The median age was 4.7 years, with boys being more common in those older than 4 years (58.5%). A total of 557 patients (57.3%) reported some symptom, and complementary tests were performed in 414 (42.7%). Another specialist was called in 315 (32.4%) cases, mainly from Ear, Nose and Throat (fish bones) or Surgery (coins). The FB was removed in 305 (31.4%) cases, which were mostly fish bones or sunflower seeds. Seventy-one patients (7.3%) were admitted, especially ingestion of fish bones or coins. No patient died. DiscussionIngestion of fish bones or coins by young children is a relatively common presentation in the PED, and it is associated with frequent medical interventions. Although the overall prognosis is good, and improving the health education of the population should be considered to reduce the frequency of these episodes.

Impacted button battery causing acquired tracheoesophageal fistula in a 2-month-old infant

A 2-month-old male infant was brought with fever and respiratory distress of 5-days duration. Investigations showed a round, radiopaque foreign body in the upper esophagus. The child was diagnosed to have coin ingestion and referred to our center for removal of the same. Careful review of the X-rays led us suspect button battery ingestion. Emergency rigid esophagoscopy and foreign body removal was performed under general endotracheal anesthesia. A rusted, 4 mm wide button battery was removed using optical forceps with difficulty. Postoperatively, the child was managed on a ventilator. He received supportive care. Check scopy done using ultrathin, flexible esophagoscope on day 10 showed acquired tracheoesophageal fistula. The child underwent defunctioning gastrostomy and feeding jejunostomy, but succumbed to sepsis from mediastinitis and recurrent pneumonitis 2 days later. Ingestion and impaction of the button battery in a 2-month-old infant are extremely rare and unreported in literature. Hence, the case report.