Author(s)
Waleed Alshareef, Saudi Board of ORL-HNS
Hasan Asiri, ORL-HNS Resident
Bshair Aldriweesh, Saudi Board ORL-HNS
Latifa Almakoshi, Consultant Pediatric ORL and Airway Surgery
Ahmad Alammar, Consultant Pediatric ORL and Airway Surgery
Affiliation(s)
King Saud Univ. Med. City, Riyadh, Saudi Arabia.
Abstract:
Coin Foreign Body Retained in the Upper Esophagus for 4 Years:A Case ReportAbstract:Introduction:Coins are among the most common foreign bodies ingested in children,especially those below 5 years of age. Early endoscopic retrieval of esophageal coinsminimizes the possible risk of serious consequences. However, significant morbidityand mortality have been reported when coins are retained in the gastrointestinal tractfor a prolonged period of time. We report a case of a retained coin in the upperesophagus for 4 years with a distinctive clinical course.Case Description:An 11-year-old girl, known to have sickle cell disease and beta thalassemia wasreferred to our center from a rural hospital as a case of foreign body (coin) esophagusevident on chest X-ray three weeks prior to presentation. The family reported suspicionof a foreign body ingestion several years ago followed by one episode of vomiting;She had no dysphagia or limitation in oral intake since then. Tracking down theradiological imaging from the referring hospital revealed the presence of a missed coinin chest X-ray 4 years back. Contrasted neck Computed Tomography and fluoroscopicswallowing study revealed that the coin had migrated to the anterior neck without clearsigns of esophageal perforation. Flexible esophagoscopy confirmed the presence ofan extraluminal foreign body. Coin removal was accomplished via transcervicalapproach without intraoperative detection of esophageal wall violation. Onpostoperative day 5, the patient started to have wound discharge and postoperativefluoroscopic swallowing study confirmed the presence of a small esophagealperforation which was managed conservatively.Discussion:A retained esophageal coin for a prolonged period may place the patient at riskof sequalae. Previous reports included a child with a retained esophageal coin for 6years which was complicated by the formation of tracheo-esophgeal fistula.Endoscopic foreign body retrieval is the current preferred approach, but surgicalremoval is required in select cases. Management of patients with a complicatedaerodigestive tract foreign body is challenging. To improve patients’ safety, the qualityof medical care in rural areas should be monitored with implementation of continuouseducational programs.