Esophageal Coins Research Articles

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.

Role of Multi-Angle Chest Radiograph in Diagnosing Esophageal Aluminum Coin.

Role of Multi-Angle Chest Radiograph in Diagnosing Esophageal Aluminum Coin.

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.

Esophageal Bougienage for Management of Lodged Esophageal Coins: Safe, Effective, Efficient, and Underused.

The aims of the study are to evaluate outcomes of esophageal bougienage for management of lodged esophageal coins and to assess the extent of bougienage usage and barriers among emergency providers. We performed a retrospective chart review of pediatric patients with single lodged esophageal coins presenting to our single academic pediatric emergency department between November 2012 and December 2018. We compared procedural outcomes, complications, length of stay (LOS), and cost between those managed with bougienage and with endoscopy. We further surveyed emergency physicians to assess the extent of bougienage usage and barriers to utilization across different institutions. We identified 205 patients with single lodged esophageal coins presenting during our study window. One hundred forty-seven patients ultimately underwent bougienage with 97% success and no major complications. Fifty-six patients were managed by endoscopy with 100% success and one major complication. Bougienage had significantly lower LOS (median 2.18 vs 11.92 hours, P < 0.001) and hospital charges (median $3533 vs $12,679, P < 0.001) compared with endoscopy. We received 242 completed surveys representing 38 states from primarily academic pediatric emergency physicians. The majority of respondents (90%) used specialist consult with only 4.5% performing bougienage. A total of 36.4% of respondents had never heard of the procedure and only 16.1% had ever performed it. Barriers to usage included lack of provider training (95.6%), perceived risk of complications (94.4%), and perceived lack of success (80.5%). Bougienage is safe and effective with significant LOS and cost benefits compared with endoscopy. Despite these advantages, the procedure is underused, because of lack of provider education and concerns regarding safety, efficacy, and both family and specialist preference, which are not supported by current literature. These data support the need for broader education regarding the bougienage technique, as well as larger prospective studies of its safety and outcomes.

Role of Point-of-Care ultrasound as a Bridge Investigation for Management of Upper Oesophageal Coins in Children.

The Sri Lankan Journal of Anaesthesiology is the official journal of the College of Anaesthesiologists of Sri Lanka. It publishes clinical investigations, research articles, audits, case reports, review articles and CME articles relating to anaesthesiology, critical care and pain. It is published bi annually in January and June. Sri Lankan Journal of Anaesthesiology is included on DOAJ and Scopus.

Coin retained in the upper esophagus for more than 4 years: A case report and literature review.

Coins are among the most common foreign bodies ingested by children, especially those below 5years of age. Early endoscopic retrieval of esophageal coins minimizes the risk of serious complications. However, significant morbidity and mortality are reported when coins are retained in the gastrointestinal tract for prolonged periods of time. We report a case in which a coin was retained in the upper esophagus for 4years and presented a distinctive clinical course. An esophageal coin retained for a prolonged period may place the patient at a risk of complications such as tracheoesophageal fistulas. The management of patients with complicated aerodigestive tract foreign bodies is challenging. To avoid a delayed diagnosis and to improve the patients' safety, the quality of medical care in rural areas should be monitored by implementing continuous educational programs for primary physicians.

Unusual radiological finding in foreign bodies ingestion: three esophageal coins

Case description: A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects. Clinical findings: The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history. Treatment and Outcome: With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications. Clinical relevance: Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.

Esophageal discoid foreign body detection and classification using artificial intelligence.

Early and accurate radiographic diagnosis is required for the management of children with radio-opaque esophageal foreign bodies. Button batteries are some of the most dangerous esophageal foreign bodies and coins are among the most common. We hypothesized that artificial intelligence could be used to triage radiographs with esophageal button batteries and coins. Our primary objective was to train an object detector to detect esophageal foreign bodies, whether button battery or coin. Our secondary objective was to train an image classifier to classify the detected foreign body as either a button battery or a coin. We trained an object detector to detect button batteries and coins. The training data set for the object detector was 57 radiographs, consisting of 3 groups of 19 images each with either an esophageal button battery, esophageal coin or no foreign body. The foreign bodies were endoscopically confirmed, and the groups were age and gender matched. We then trained an image classifier to classify the detected foreign body as either a button battery or a coin. The training data set for the image classifier consisted of 19 radiographs of button batteries and 19 of coins, cropped from the object detector training data set. The object detector and image classifier were then tested on 103 radiographs with an esophageal foreign body, and 103 radiographs without a foreign body. The object detector was 100% sensitive and specific for detecting an esophageal foreign body. The image classifier accurately classified all 6/6 (100%) button batteries in the testing data set and 93/95 (97.9%) of the coins. The remaining two coins were incorrectly classified as button batteries. In addition to these images with a single button battery or coin, there were two unique cases in the testing data set: a stacked button battery and coin, and two stacked coins, both of which were classified as coins. Artificial intelligence models show promise in detecting and classifying esophageal discoid foreign bodies and could potentially be used to triage radiographs for radiologist interpretation.

Ingestion of metallic foreign bodies: A Paediatric Emergency Research in the United Kingdom and Ireland survey of current practice and hand‐held metal detector use

To describe variation in the initial management of children presenting to Emergency Departments (ED) with coins lodged in the oesophagus. To determine the usage of hand-held metal detectors (HHMDs) in EDs, including their role in clinical decision-making, and training in their use. Online multicentre cross-sectional survey of EDs in the UK and Ireland, with results described using descriptive statistics. Fifty-five (90%) of 61 sites responded. The two main strategies described for lodged oesophageal coins were endoscopic removal or observation with reassessment, dependent on location. For coins in the proximal third of the oesophagus 43/55 (78.2%) referred for endoscopic removal, 6/55 (10.9%) observed and the remaining 10.9% used a variety of methods, including: Foley catheter removal with fluoroscopy, blind Foley catheter removal, referral to paediatric surgery/ENT. Thirty (55%) of 55 used HHMDs, 21/30 (70%) had guidelines for their use, and 3/30 (10%) provided formal training. Twenty (67%) of 30 used the xiphisternum as the anatomical cut-off for assuming safe passage of metallic foreign bodies (FB) beyond the lower oesophageal sphincter. There is considerable variation in the management of oesophageal coins in children, though two dominant strategies were identified. As endoscopy is significantly more invasive than observation, future research should aim to determine whether either is more effective and safer in children. There is a clear division in departmental adoption of HHMDs. However, in those sites using HHMDs there was little formal training in their use, and there are large variations in techniques and their role in clinical decision-making.

Three Coins in Esophagus, at the Same Locaton and Same Alignment â A Very Rare Occurrence

Introducton: Foreign body ingestons are common in paediatric age group. Coin is one of the most commonly ingested foreign bodies in children. Multple coin swallowing is not very common and only a few cases have been reported. A case of multple coin ingeston with perfect radiological alignment is phenomenally rare. Case Report: We present an interestng case of triple coin ingeston by a 10 yr old child with no known prior history. Conclusion: Till now there has been no case of three coins aligned similarly at the same level in the literature. This case is being reported due to its rarity being the frst case tll date.

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.

Impacted Coin in Esophagus in a 5 year Old Child

Foreign body ingestion is more common in children than in adults. Coin is the most common foreign body impaction seen in children and usually occurs at the level of Cricopharynx.

Open Thoracic Surgery for Removal of a Two-Year-Old Impacted Esophageal Coin

Introduction: Esophageal foreign bodies are important and serious cause of morbidity and mortality in both children and adults, usually as a result of serious complications, such as perforation, necrosis, mediastinitis, and fistulation. Therefore, rapid and accurate diagnosis with subsequent removal is very important. Clinical Case: We present and discuss the presentation, diagnosis and surgical management of a 6-year-old with a 2-year history of ingested coin locked in the oesophagus. Discussion: Diagnosis was established by upper gastrointestinal endoscopy, barium swallow and chest x-ray. The coin was removed by open surgery via oesophagotomy through right thoracotomy after failed retrieval via rigid oesophagoscopy. Conclusion: Surgical treatment in the form of esophagotomy via thoracotomy may be necessary in some cases of impacted foreign bodies in the esophagus where endoscopic removal is unsuccessful.

Contrasting esophageal coin removal in countries with different sized coins in circulation

Contrasting esophageal coin removal in countries with different sized coins in circulation

3202 Where Is the Coin?

INTRODUCTION: Foreign body ingestions are a common presenting complaint in the emergency department. Nearly 80 percent of the greater than 100,000 cases annually are in children. Coins are the most frequently ingested item in children. Most coins pass uneventfully, however they may get lodged at the level of the thoracic inlet, at the level of the arch of the aorta or at the gastroesophageal junction. Urgent evaluation involves obtaining a chest radiograph. Ingested coins found in the esophagus are oriented coronally on a posteroanterior (PA) radiograph. However, coins lodged in the trachea are oriented sagitally (due to the longitudinal orientation of the larynx and the incomplete C rings of the trachea, allowing a longer antero-posterior diameter of the trachea). We present a child with esophageal coin oriented sagitally on PA chest X-ray. CASE DESCRIPTION/METHODS: A healthy six year old boy presented to the Emergency Room with severe chest pain an hour after swallowing a nickel. There were no respiratory symptoms. On chest X-ray the coin was seen “on edge” on the PA view and “en-face” on the lateral view, below the level of carina. CT scan revealed the coin sagitally oriented in the esophagus at the level of the gastroesophageal junction. Due to persistence of chest pain he underwent endoscopy immediately after CT scan. At endoscopy under general anesthesia the coin- a nickel, was seen in the stomach and retrieved. The esophagus appeared normal. DISCUSSION: Even though most ingested coins are oriented coronally in the esophagus, our case demonstrates that coins in the esophagus may be oriented sagitally as well. Review of the literature revealed a study with 8 cases of sagittally oriented esophageal coins. In these children, 7 of the 8 were at the level of the aortic arch, while the other was at the distal esophagus, as was seen in our patient. The cause of the sagittal orientation is speculative; and may be related to peristalsis and a smaller sized coin.

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.

Novel Bougie for the Management of Esophageal Coins in Children: An Observational Study.

To determine the efficacy and safety of a novel bougie for the removal of esophageal coins lodged in the proximal esophagus. This was an observational study. Medical records were reviewed of patients who were confirmed with esophageal coins between July 2015 and October 2016 in our department. Sixty-three patients, upper esophageal coins were confirmed by radiographs, were treated by using this novel bougie to remove esophageal coins. A total of 63 children were enrolled in this study. Sixty coins (95%) were removed successfully. The coin was extracted on the first attempt in 56 cases (89%), the second attempt in 3 cases (5%), and the third attempt in 1 case (2%). Two coins retained in the esophagus underwent endoscopy. In the remaining patient, the coin passed into the stomach and was confirmed to be passed in the stool within 48 hours. No serious complications occurred in any subject. Our novel bougie procedure is likely a safe, highly efficient approach to managing esophageal coins given that no serious complications of the 63 patients were reported. This simple technique may provide another valuable option to physicians.

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.