| Title | Acute esophageal coin ingestions: is immediate removal necessary? | | Author(s) | Sharieff GQ, Brousseau TJ, Bradshaw JA, Shad JA | | Institution | Department of Emergency Medicine, University of Florida Health Science Center Shands, 655 W Eigth Street, Jacksonville, FL 32209, USA. | | Source | Pediatr Radiol 2003 Dec; 33(12):859-63. | | MeSH | Child
Child, Preschool
Clinical Protocols
Esophagus
Female
Fluoroscopy
Foreign Bodies
Humans
Infant
Male
Retrospective Studies
Time Factors
| | Abstract | AIMS: Coins are the most commonly encountered foreign body ingestions presenting to the emergency department (ED). The purpose of our study was to retrospectively evaluate a new institutional protocol implemented in 1998, in which healthy patients with acute (less than 24 h) coin ingestions located below the thoracic inlet, were observed at home with next-day follow-up. If repeat radiographs revealed a persistent esophageal foreign body, then the coin was removed.
METHODS: The charts of all patients who presented to the ED with a complaint of esophageal foreign body were reviewed from 1 January 1998 until 31 December 2001. Patients were excluded if they had non-acute ingestions, known esophageal pathology, severe symptoms such as stridor or inability to tolerate oral fluids, or incomplete records.
RESULTS: Of 31 patients with esophageal coin ingestions, 16 had coins above the thoracic inlet. Three of these patients were asymptomatic and all experienced spontaneous coin passage into the stomach within 2 h of ED presentation while awaiting coin removal. There were eight eligible patients with coins located below the thoracic inlet. Three of five patients with mid-esophageal coins experienced spontaneous coin passage while the remaining two required coin removal on next-day follow-up for persistent esophageal coins. Three of three patients with distal-esophageal coin ingestions experienced spontaneous coin passage. There were no complications in any of the patients who underwent delayed coin removal either due to the procedure itself or to a delay in therapy.
CONCLUSIONS: Patients with acute esophageal coin ingestions may experience spontaneous coin passage and therefore, patients with coins located below the thoracic inlet with minor symptoms may be candidates for next-day follow-up. If repeat radiographs reveal a persistent esophageal coin, then the coin should be immediately removed. Furthermore, asymptomatic patients with coins above the thoracic inlet should undergo repeat radiographs in 2-5 h, as spontaneous coin passage may occur. Our protocol may also be more convenient and cost-effective as patients can be observed at home. | | Language | eng | | Pub Type(s) | Evaluation Studies
Journal Article
| | PubMed ID | 14551754 |
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