Coin Ingestion in an 8-Year-Old Child; An Atypical Presentation

Foreign body ingestion can occur in the children of all ages but it’s more common between 6 months to 4 years of age. Most
ingested foreign bodies will pass through the gastrointestinal tract spontaneously without any intervention. Coins are one of the usual
ingested objects. Coins in the esophagus are often oriented coronally in the erect chest X-ray and tracheal foreign bodies are more
commonly in the sagittal orientation. Here, we report an 8-year-old boy who was brought to our emergency department, after an accidentalingestion of a coin, 30 minutes prior. On arrival, he was alert, awake, hemodynamically stable, without any distress, dyspnoea,
drooling, odynophagia or other gastrointestinal or respiratory symptoms. Chest x-ray revealed a metallic foreign body consistent
with coin with sagittal orientation, which raised the concern for airway foreign body. Despite the patient being stable and completely
asymptomatic, he was admitted in the pediatricsurgical ward for close observation and serial examination. Repeat CXR and AXR 6
hours post admission, revealed the coin location below diaphragm in the stomach. He was subsequently discharged home with advice
and arranged outpatient follow-up. The larger size of esophagus in the older children may increase the probability of the esophageal
sagittal orientation, and due to high incidence of an esophageal ingestion rather than a tracheal aspiration, a sagittally oriented coin
should be consider as esophageal ingestion unless the contrary is proved.