Coin ingestion - Revision history

Danbot: Strip excess bold

2026-03-22T09:29:44Z

Strip excess bold

Danbot: Danbot moved page Coin Ingestion to Coin ingestion without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

2026-03-22T05:31:24Z

Danbot moved page Coin Ingestion to Coin ingestion without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

← Older revision	Revision as of 05:31, 22 March 2026
(No difference)

Danbot: Formatting: removed bold

2026-03-19T16:12:05Z

Formatting: removed bold

Show changes

Ostermayer: Created page with "==Background== Coins are the '''most commonly ingested foreign body''' in children, accounting for the majority of pediatric foreign body ingestion ED visitsKramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. PMID 25611037. Peak age: '''6 months to 3 years''' (exploratory mouthing behavior) *The vast..."

2026-03-13T11:57:08Z

Created page with "==Background== *Coins are the '''most commonly ingested foreign body''' in children, accounting for the majority of pediatric foreign body ingestion ED visits<ref name="naspghan">Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. PMID 25611037.</ref> *Peak age: '''6 months to 3 years''' (exploratory mouthing behavior) *The vast..."

New page

==Background==
*Coins are the '''most commonly ingested foreign body''' in children, accounting for the majority of pediatric foreign body ingestion ED visits<ref name="naspghan">Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. PMID 25611037.</ref>
*Peak age: '''6 months to 3 years''' (exploratory mouthing behavior)
*The vast majority of ingested coins pass through the GI tract '''spontaneously without complication'''
*Coins that reach the stomach have a > 95% chance of passing without intervention<ref name="conners">Conners GP. Pediatric foreign body ingestion: complications and patient and foreign body factors. ''Sci''. 2022;4(2):20.</ref>
*The primary concern is '''esophageal impaction''', which occurs in approximately 10–20% of pediatric coin ingestions<ref name="waltzman">Waltzman ML, Baskin M, Wypij D, et al. A randomized clinical trial of the management of esophageal coins in children. ''Pediatrics''. 2005;116(3):614-619. PMID 16140700.</ref>
*Esophageal impaction most commonly occurs at one of three anatomic narrowings:
**'''Upper esophageal sphincter (cricopharyngeus)''' — most common site (~70%)
**'''Aortic arch / carina level''' (mid-esophagus)
**'''Lower esophageal sphincter''' (GE junction)
*Serious complications from coin ingestion (perforation, fistula, obstruction) are '''extremely rare''' but can occur with prolonged esophageal impaction<ref name="naspghan"/>
*'''Critical distinction:''' Coins must be differentiated from '''[[Button battery ingestion|button batteries]]''' on radiograph — batteries require emergent removal, coins generally do not
*Adult coin ingestions are uncommon and raise concern for underlying esophageal pathology (stricture, eosinophilic esophagitis, Schatzki ring) or psychiatric/developmental conditions

==Clinical Features==
===Asymptomatic (Most Common)===
*Many coin ingestions, particularly those past the esophagus, are '''completely asymptomatic'''
*Parents may witness the ingestion or find a coin is missing
*The child may be entirely well-appearing with a normal exam

===Esophageal Impaction===
*Dysphagia, odynophagia
*Drooling, refusal to eat or drink
*Vomiting or gagging
*Chest pain, neck pain, throat discomfort ("something stuck")
*Irritability, fussiness (nonverbal children)
*Cough, stridor, or wheezing (compression of the posterior membranous trachea by a proximal esophageal coin)

===Post-Esophageal (Gastric / Intestinal)===
*Typically asymptomatic
*Rare: abdominal pain, vomiting if coin causes gastric outlet obstruction or fails to pass a fixed anatomic narrowing (e.g. pylorus, ileocecal valve, prior surgical site)

===Delayed / Missed Ingestion===
*Chronic cough, recurrent wheezing, or feeding difficulties may be the only presentation if the ingestion was unwitnessed
*Consider coin (or other foreign body) in any child with unexplained respiratory or feeding symptoms<ref name="conners"/>

==Differential Diagnosis==
*'''[[Button battery ingestion]]''' — '''must be excluded radiographically before observation''' (see Diagnosis for distinguishing features)
*Other [[Foreign Body Ingestion|foreign body ingestion]] (magnets, small toys, jewelry)
*[[Esophageal Food Impaction|Food bolus impaction]]
*[[Epiglottitis]], [[Croup]] (if airway symptoms)
*[[GERD]], eosinophilic esophagitis
*[[Esophageal Stricture]]
*Retropharyngeal abscess (if neck pain, drooling, refusal to eat)
*Swallowed [[Magnet Ingestion|magnets]] (single magnet = low risk; multiple magnets = surgical emergency)

==Evaluation==
===Workup===
*'''AP and lateral radiographs''' of the neck, chest, and abdomen — '''standard of care for all suspected coin ingestions'''<ref name="naspghan"/>
**Coins are radiopaque and readily identified
**Must image from nasopharynx to rectum if location is uncertain
*'''Labs:''' Generally NOT needed for uncomplicated coin ingestion
**Obtain CBC, BMP, type and screen if there is concern for perforation, hemorrhage, or the patient requires procedural sedation/general anesthesia for removal

===Diagnosis===
*'''Coin vs. Button Battery on X-ray:'''
{| class="wikitable"
|-
! Feature !! Coin !! Button Battery
|-
| '''AP view''' || '''Single uniform disc'''; no double ring || '''"Double ring" / "halo" sign''' (step-off between anode and cathode layers)
|-
| '''Lateral view''' || '''Uniformly thin''' || '''Step-off''' (one side wider than the other)
|-
| '''Orientation in esophagus''' || '''Coronal''' (flat face toward AP viewer — appears round on AP) || Also coronal in esophagus
|}
*'''If the object cannot be definitively identified as a coin, manage as a [[Button battery ingestion|button battery]] until proven otherwise'''
*'''Coin orientation helps localize:'''
**'''Esophagus:''' Coin is oriented in the '''coronal''' plane (appears round on AP view, thin line on lateral)
**'''Trachea:''' Coin is oriented in the '''sagittal''' plane (appears thin on AP, round on lateral) — indicates aspiration rather than ingestion
*'''Identify the exact location:''' Esophagus vs. stomach vs. beyond — this determines management

===Consider Underlying Pathology===
*Recurrent esophageal coin impaction or food impaction → workup for '''eosinophilic esophagitis''', esophageal stricture, vascular ring, or other anatomic abnormality<ref name="naspghan"/>
*Adult with esophageal coin impaction → underlying pathology is very likely

==Management==
===Esophageal Coin===
*'''Proximal esophagus (cricopharyngeus):'''
**Endoscopic removal is recommended — '''urgent''' (within 24 hours)<ref name="naspghan"/>
**Some centers perform removal sooner (within 12–16 hours) if the coin has been lodged for an unknown duration
*'''Mid or distal esophagus in an asymptomatic child:'''
**A brief observation period of '''12–24 hours''' to allow spontaneous passage into the stomach is reasonable<ref name="waltzman"/>
**65% of mid/distal esophageal coins pass spontaneously within 12–24 hours<ref name="waltzman"/>
**Repeat radiograph at 12–24 hours; if coin has not passed → endoscopic removal
**'''Do NOT observe''' if the child is symptomatic, if the duration of impaction is unknown, or if the child has prior esophageal pathology
*'''Removal techniques:'''
**'''Endoscopy:''' Preferred method — allows direct mucosal inspection and treatment of concurrent pathology (e.g. eosinophilic esophagitis biopsies)<ref name="naspghan"/>
**'''Foley catheter technique:''' Fluoroscopically guided balloon catheter passed beyond the coin, inflated, and withdrawn to pull the coin out. Used at some centers for recently impacted (< 24 hours), smooth, round coins in proximal esophagus of otherwise healthy children with no prior esophageal pathology. Controversial; risk of aspiration; not universally endorsed
**'''Bougienage (coin advancement):''' Esophageal bougie is used to push the coin into the stomach. Used at some centers for distal esophageal coins. Also controversial; no mucosal inspection possible
*'''NPO''' in anticipation of procedural sedation/anesthesia for removal

===Gastric Coin===
*'''Observation is the standard of care''' — the vast majority pass spontaneously<ref name="conners"/>
*No specific dietary modification required; normal diet
*Parents should monitor stools for coin passage (though this is often missed)
*'''Repeat radiograph:'''
**Some guidelines suggest repeat imaging '''only if the coin has not passed within 2–4 weeks'''<ref name="naspghan"/>
**Earlier repeat imaging (at 1–2 weeks) may be considered for larger coins or younger children
*'''Endoscopic removal if:'''
**Coin remains in the stomach > 2–4 weeks
**Patient becomes symptomatic (abdominal pain, vomiting, hematemesis)

===Post-Gastric (Intestinal) Coin===
*'''No intervention needed''' — will pass in stool
*Return precautions for abdominal pain, vomiting, bloody stools

===Airway (Aspirated Coin)===
*'''Emergent bronchoscopy''' — coin in the trachea or bronchus requires immediate removal
*Identified by sagittal orientation on AP radiograph

==Disposition==
*'''Discharge home:'''
**Asymptomatic child with coin confirmed in the '''stomach or beyond''' on radiograph
**Provide written return precautions: vomiting, abdominal pain, bloody stool, refusal to eat, fever
**Follow-up radiograph in 2–4 weeks if passage is not confirmed
*'''Discharge home with planned follow-up (12–24 hours):'''
**Asymptomatic child with coin in '''mid or distal esophagus''' being observed for spontaneous passage
**Must have reliable parents/caregivers and ability to return promptly
**Repeat imaging in 12–24 hours; return immediately if symptoms develop
*'''Admit / procedural intervention:'''
**Symptomatic esophageal coin requiring endoscopic removal
**Proximal esophageal coin (unlikely to pass spontaneously)
**Coin that fails to pass after 12–24 hour observation period
**Coin in the trachea (emergent bronchoscopy)
**Any concern for button battery rather than coin → treat as battery
*'''Referral to GI:'''
**Recurrent esophageal foreign body impaction (evaluate for eosinophilic esophagitis, stricture)
**Gastric coin persisting > 2–4 weeks

==See Also==
*[[Button battery ingestion]]
*[[Foreign body ingestion]]
*[[Esophageal foreign body]]
*[[Magnet ingestion]]
*[[Esophageal food impaction]]
*[[Pediatric foreign body]]

==External Links==
*[https://naspghan.org/files/documents/pdfs/cme/jpgn/Management_of_Ingested_Foreign_Bodies_in_Children_.28.pdf Management of Ingested Foreign Bodies in Children - NASPGHAN/ESPGHAN 2015]
*[https://pubmed.ncbi.nlm.nih.gov/16140700/ Randomized clinical trial of management of esophageal coins in children - Pediatrics 2005]
*[https://www.mdpi.com/2413-4155/4/2/20 Pediatric foreign body ingestion: complications and factors - Sci 2022]
*[https://www.poison.org/battery/guideline National Capital Poison Center: Button Battery Triage and Treatment Guideline]

==References==
<references/>

[[Category:GI]] [[Category:Pediatrics]]

← Older revision		Revision as of 09:29, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Coins are the ~~'''~~most commonly ingested foreign body~~'''~~ in children, accounting for the majority of pediatric foreign body ingestion ED visits<ref name="naspghan">Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. PMID 25611037.</ref>		*Coins are the most commonly ingested foreign body in children, accounting for the majority of pediatric foreign body ingestion ED visits<ref name="naspghan">Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. PMID 25611037.</ref>
	*Peak age: ~~'''~~6 months to 3 years~~'''~~ (exploratory mouthing behavior)		*Peak age: 6 months to 3 years (exploratory mouthing behavior)
	*The vast majority of ingested coins pass through the GI tract ~~'''~~spontaneously without complication~~'''~~		*The vast majority of ingested coins pass through the GI tract spontaneously without complication
	*Coins that reach the stomach have a > 95% chance of passing without intervention<ref name="conners">Conners GP. Pediatric foreign body ingestion: complications and patient and foreign body factors. ''Sci''. 2022;4(2):20.</ref>		*Coins that reach the stomach have a > 95% chance of passing without intervention<ref name="conners">Conners GP. Pediatric foreign body ingestion: complications and patient and foreign body factors. ''Sci''. 2022;4(2):20.</ref>
	*The primary concern is ~~'''~~esophageal impaction~~'''~~, which occurs in approximately 10–20% of pediatric coin ingestions<ref name="waltzman">Waltzman ML, Baskin M, Wypij D, et al. A randomized clinical trial of the management of esophageal coins in children. ''Pediatrics''. 2005;116(3):614-619. PMID 16140700.</ref>		*The primary concern is esophageal impaction, which occurs in approximately 10–20% of pediatric coin ingestions<ref name="waltzman">Waltzman ML, Baskin M, Wypij D, et al. A randomized clinical trial of the management of esophageal coins in children. ''Pediatrics''. 2005;116(3):614-619. PMID 16140700.</ref>
	*Esophageal impaction most commonly occurs at one of three anatomic narrowings:		*Esophageal impaction most commonly occurs at one of three anatomic narrowings:
	**Upper esophageal sphincter (cricopharyngeus) — most common site (~70%)		**Upper esophageal sphincter (cricopharyngeus) — most common site (~70%)
	**Aortic arch / carina level (mid-esophagus)		**Aortic arch / carina level (mid-esophagus)
	**Lower esophageal sphincter (GE junction)		**Lower esophageal sphincter (GE junction)
	*Serious complications from coin ingestion (perforation, fistula, obstruction) are ~~'''~~extremely rare~~'''~~ but can occur with prolonged esophageal impaction<ref name="naspghan"/>		*Serious complications from coin ingestion (perforation, fistula, obstruction) are extremely rare but can occur with prolonged esophageal impaction<ref name="naspghan"/>
	*Critical distinction: Coins must be differentiated from '''[[Button battery ingestion\|button batteries]]''' on radiograph — batteries require emergent removal, coins generally do not		*Critical distinction: Coins must be differentiated from '''[[Button battery ingestion\|button batteries]]''' on radiograph — batteries require emergent removal, coins generally do not
	*Adult coin ingestions are uncommon and raise concern for underlying esophageal pathology (stricture, eosinophilic esophagitis, Schatzki ring) or psychiatric/developmental conditions		*Adult coin ingestions are uncommon and raise concern for underlying esophageal pathology (stricture, eosinophilic esophagitis, Schatzki ring) or psychiatric/developmental conditions
Line 15:		Line 15:
	==Clinical Features==		==Clinical Features==
	===Asymptomatic (Most Common)===		===Asymptomatic (Most Common)===
	*Many coin ingestions, particularly those past the esophagus, are ~~'''~~completely asymptomatic~~'''~~		*Many coin ingestions, particularly those past the esophagus, are completely asymptomatic
	*Parents may witness the ingestion or find a coin is missing		*Parents may witness the ingestion or find a coin is missing
	*The child may be entirely well-appearing with a normal exam		*The child may be entirely well-appearing with a normal exam
Line 47:		Line 47:
	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*AP and lateral radiographs of the neck, chest, and abdomen — ~~'''~~standard of care for all suspected coin ingestions~~'''~~<ref name="naspghan"/>		*AP and lateral radiographs of the neck, chest, and abdomen — standard of care for all suspected coin ingestions<ref name="naspghan"/>
	**Coins are radiopaque and readily identified		**Coins are radiopaque and readily identified
	**Must image from nasopharynx to rectum if location is uncertain		**Must image from nasopharynx to rectum if location is uncertain
Line 67:		Line 67:
	*If the object cannot be definitively identified as a coin, manage as a [[Button battery ingestion\|button battery]] until proven otherwise		*If the object cannot be definitively identified as a coin, manage as a [[Button battery ingestion\|button battery]] until proven otherwise
	*Coin orientation helps localize:		*Coin orientation helps localize:
	**Esophagus: Coin is oriented in the ~~'''~~coronal~~'''~~ plane (appears round on AP view, thin line on lateral)		**Esophagus: Coin is oriented in the coronal plane (appears round on AP view, thin line on lateral)
	**Trachea: Coin is oriented in the ~~'''~~sagittal~~'''~~ plane (appears thin on AP, round on lateral) — indicates aspiration rather than ingestion		**Trachea: Coin is oriented in the sagittal plane (appears thin on AP, round on lateral) — indicates aspiration rather than ingestion
	*Identify the exact location: Esophagus vs. stomach vs. beyond — this determines management		*Identify the exact location: Esophagus vs. stomach vs. beyond — this determines management

	===Consider Underlying Pathology===		===Consider Underlying Pathology===
	*Recurrent esophageal coin impaction or food impaction → workup for ~~'''~~eosinophilic esophagitis~~'''~~, esophageal stricture, vascular ring, or other anatomic abnormality<ref name="naspghan"/>		*Recurrent esophageal coin impaction or food impaction → workup for eosinophilic esophagitis, esophageal stricture, vascular ring, or other anatomic abnormality<ref name="naspghan"/>
	*Adult with esophageal coin impaction → underlying pathology is very likely		*Adult with esophageal coin impaction → underlying pathology is very likely

Line 78:		Line 78:
	===Esophageal Coin===		===Esophageal Coin===
	*Proximal esophagus (cricopharyngeus):		*Proximal esophagus (cricopharyngeus):
	**Endoscopic removal is recommended — ~~'''~~urgent~~'''~~ (within 24 hours)<ref name="naspghan"/>		**Endoscopic removal is recommended — urgent (within 24 hours)<ref name="naspghan"/>
	**Some centers perform removal sooner (within 12–16 hours) if the coin has been lodged for an unknown duration		**Some centers perform removal sooner (within 12–16 hours) if the coin has been lodged for an unknown duration
	*Mid or distal esophagus in an asymptomatic child:		*Mid or distal esophagus in an asymptomatic child:
	**A brief observation period of ~~'''~~12–24 hours~~'''~~ to allow spontaneous passage into the stomach is reasonable<ref name="waltzman"/>		**A brief observation period of 12–24 hours to allow spontaneous passage into the stomach is reasonable<ref name="waltzman"/>
	**65% of mid/distal esophageal coins pass spontaneously within 12–24 hours<ref name="waltzman"/>		**65% of mid/distal esophageal coins pass spontaneously within 12–24 hours<ref name="waltzman"/>
	**Repeat radiograph at 12–24 hours; if coin has not passed → endoscopic removal		**Repeat radiograph at 12–24 hours; if coin has not passed → endoscopic removal
Line 96:		Line 96:
	*Parents should monitor stools for coin passage (though this is often missed)		*Parents should monitor stools for coin passage (though this is often missed)
	*Repeat radiograph:		*Repeat radiograph:
	**Some guidelines suggest repeat imaging ~~'''~~only if the coin has not passed within 2–4 weeks~~'''~~<ref name="naspghan"/>		**Some guidelines suggest repeat imaging only if the coin has not passed within 2–4 weeks<ref name="naspghan"/>
	**Earlier repeat imaging (at 1–2 weeks) may be considered for larger coins or younger children		**Earlier repeat imaging (at 1–2 weeks) may be considered for larger coins or younger children
	*Endoscopic removal if:		*Endoscopic removal if:
Line 107:		Line 107:

	===Airway (Aspirated Coin)===		===Airway (Aspirated Coin)===
	*~~'''~~Emergent bronchoscopy~~'''~~ — coin in the trachea or bronchus requires immediate removal		*Emergent bronchoscopy — coin in the trachea or bronchus requires immediate removal
	*Identified by sagittal orientation on AP radiograph		*Identified by sagittal orientation on AP radiograph

	==Disposition==		==Disposition==
	*Discharge home:		*Discharge home:
	**Asymptomatic child with coin confirmed in the ~~'''~~stomach or beyond~~'''~~ on radiograph		**Asymptomatic child with coin confirmed in the stomach or beyond on radiograph
	**Provide written return precautions: vomiting, abdominal pain, bloody stool, refusal to eat, fever		**Provide written return precautions: vomiting, abdominal pain, bloody stool, refusal to eat, fever
	**Follow-up radiograph in 2–4 weeks if passage is not confirmed		**Follow-up radiograph in 2–4 weeks if passage is not confirmed
	*Discharge home with planned follow-up (12–24 hours):		*Discharge home with planned follow-up (12–24 hours):
	**Asymptomatic child with coin in ~~'''~~mid or distal esophagus~~'''~~ being observed for spontaneous passage		**Asymptomatic child with coin in mid or distal esophagus being observed for spontaneous passage
	**Must have reliable parents/caregivers and ability to return promptly		**Must have reliable parents/caregivers and ability to return promptly
	**Repeat imaging in 12–24 hours; return immediately if symptoms develop		**Repeat imaging in 12–24 hours; return immediately if symptoms develop