Main Article Content
A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects.
The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history.
Treatment and Outcome:
With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications.
Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.
Heinzerling NP, Christensen MA, Swedler R, Cassidy LD, Calkins CM, Sato TT. Safe and effective management of esophageal coins in children with bougienage. Surg (United States) 2015;158:1065-1072. https://doi.org/10.1016/j.surg.2015.06.025
McNeill MB, Sperry SLW, Crockett SD, Miller CB, Shaheen NJ, Dellon ES. Epidemiology and management of oesophageal coin impaction in children. Dig Liver Dis. 2012;44:482-486. https://doi.org/10.1016/j.dld.2012.01.001
Dedhia K, Chang YF, Leonardis R, Chi DH. Is there a need for repeat radiologic examination of children with esophageal coin foreign body. Otolaryngol - Head Neck Surg (United States) 2017;156(1):173-179. https://doi.org/10.1177/0194599816667039
Pérez A, Molina AY, Goñi C. Impaction of button batteries in the esophagus a potentially fatal surgical emergency in infancy. An Sist Sanit Navar. 2020;43:255-260. https://doi.org/10.23938/ASSN.0874
Nafousi O, Pertwee R, Roland D, Acheson J. Management of oesophageal coins in children. Emerg Med J. 2013;30(2):157-158. doi: 10.1136/emermed-2011-200958. https://doi.org/10.1136/emermed-2011-200958
Ormeño A. Inusual hallazgo de dos monedas juntas en esófago de pacientes pediátricos Reporte de dos casos. Rev Gastroenterol Peru. 2016;36(4):373-375
Shatani N, Alshaibani S, Potts J, Phillips B, Bray H. Chest radiograph alone is sufficient as the foreign body survey for children presenting with coin ingestion. Pediatr Emerg Care. 2021;37(9):e524-e527. https://doi.org/10.1097/PEC.0000000000001688
Huyett P, Shaffer A, Flom L, Simons JP, Jabbour N. Accuracy of chest X-Ray measurements of pediatric esophageal coins. Int J Pediatr Otorhinolaryngol. 2018;113:1-3. https://doi.org/10.1016/j.ijporl.2018.07.011
Raney LH, Losek JD. Child with esophageal coin and atypical radiograph. J Emerg Med. 2008;34:63-66 https://doi.org/10.1016/j.jemermed.2007.03.004
Schlesinger AE, Crowe JE. Sagittal orientation of ingested coins in the esophagus in children. Am J Roentgenol. 2011;196(3):670-672. https://doi.org/10.2214/AJR.10.5386
Ángel ALA, León SLP, Martínez GDC, Jurado GM. Cuerpo extraño incidental en tracto gastrointestinal Reporte de tres casos y revisión de la literatura. Rev Colomb Gastroenterol. 2011;26(4):316-327.
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use