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A Penny's Worth of Advice: Deep Esophageal Injury From a Coin

Puthoor, Pamela R.; Hoffenberg, Edward; Friedlander, Joel

Journal of Pediatric Gastroenterology and Nutrition: December 2015 - Volume 61 - Issue 6 - p e27
doi: 10.1097/MPG.0000000000000355
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Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Digestive Health Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Health Sciences Center, Aurora.

Address correspondence and reprint requests to Joel Friedlander, DO, MBe, Digestive Health Institute, Anschutz Medical Campus, 13123 16th Ave, B290, Aurora, CO 80045 (e-mail: joel.friedlander@childrenscolorado.org).

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

A healthy 15-month-old Hispanic boy presented with dysphagia. The symptoms began without fever, rhinorrhea, or cough. He was immediately taken to the local urgent care and diagnosed with an upper respiratory infection. Four days later he returned for persistent symptoms without hematemesis or fever. A chest radiograph noted a round object at the carina, Fig. 1A. Emergent esophagogastroduodenoscopy was performed. The coin was removed using rat tooth forceps. Upon inspection of the esophagus, the area was noted to have a significant mucosal erosion, Fig. 1B. The patient was admitted for observation. A water-soluble contrast esophagram noted a large mucosal irregularity without perforation Fig. 1C. After observation, the patient was discharged home on a liquid and soft diet. Follow-up demonstrated a significantly improved but ongoing mucosal diverticulum and absence of dysphagia.

FIGURE 1

FIGURE 1

Although complications from esophageal coins are rare, patients with retained esophageal coins are at risk for strictures, perforation, fistula to the great vessels, and respiratory distress (1). This case highlights the importance of prompt removal of retained esophageal foreign bodies (2). Although mucosal injury can be seen on emergent esophagogastroduodenoscopy, the injury may be greater and longer lasting than visualized. Subsequent imaging after removal may be warranted (3).

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REFERENCES

1. Wright CC, Closson FT. Updates in pediatric gastrointestinal foreign bodies. Pediatr Clin North Am 2013; 60:1221–1239.
2. McNeill MB, Sperry SL, Crockett SD, et al. Epidemiology and management of oesophageal coin impaction in children. Dig Liver Dis 2012; 44:482–486.
3. Fisher J, Mittal R, Hill S, et al. Yield of chest radiography after removal of esophageal foreign bodies. Pediatrics 2013; 131:e1497–e1501.
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