SYMPTOMS AND SPONTANEOUS PASSAGE OF ESOPHAGEAL COINS

Objectives: To determine whether coins located in different portions o f the esophagus differ in their likelihood of spontaneous clearance, a nd to determine the frequency of asymptomaticity among children with e sophageal coins. Design: Retrospective case review. Setting: Pediatric academic tertiary care center. Patients: All 73 children presenting i n an 18-month period to a pediatric emergency department for coin inge stion whose roentgenographic evaluation revealed an esophageal coin. I nterventions: None. Outcome Measures: Hospital records of all children were reviewed for demographic information, coin denominations, esopha geal locations of ingested coins based on roentgenographic reports, pe rformance of invasive removal procedures, and the presence or absence of signs and/or symptoms. Results: All of the 58 children with proxima l or middle esophageal coins underwent invasive removal procedures, wh ile nine (60%) of 15 distal esophageal coins passed into the stomach s pontaneously (P<.001). Five children (7%) were asymptomatic. Conclusio ns: Proximal and middle esophageal coins should be promptly removed, a s per present practice. Children with distal esophageal coins should b e observed up to 24 hours before an invasive removal procedure, since many will spontaneously clear their coins. Since esophageal coins may be asymptomatic, all children who have swallowed coins should undergo roentgenographic evaluation.