Ingestions of Coins

Depends on the type and dimensions of the FB

Ingested small FB typically pass through the GI tract spontaneously.

Mucosal injury and acute inflammation may occur (e.g., sharp edge, toxic or irritant material).

Often asymptomatic

Transient chest discomfort and dysphagia as the FB progresses through the esophagus

Drooling, difficulty swallowing, and retrosternal pain may indicate esophageal impaction.

FB located in the stomach and intestine are usually asymptomatic.

Ingestion is typically either self-reported or reported by a third person (e.g., parent) who witnessed or suspected ingestion.

Radiographs: findings depend on the type and radiopacity of the FB

It is important to distinguish between coins and button batteries on x-ray

Expectant management

• Patients with a small, blunt FB (e.g., coin) located in the esophagus for < 24 hours without severe symptoms

• Asymptomatic patients with a small, blunt FB located in the stomach or intestine

Emergency endoscopy (< 2 hours): indicated in any type of FB lodged in the esophagus causing severe respiratory symptoms, drooling, and/or difficulty swallowing.

Urgent endoscopy (< 24 hours): indicated in case of coin lodged in the esophagus that was ingested > 24 hours ago or unknown time of ingestion

Elective endoscopy: indicated in case of coin retained in the stomach/duodenal bulb for > 4 weeks

Surgery: indicated in case of coin retained in the intestine for > 4 weeks

Rare

Usually resolves spontaneously