Objective: To determine the frequency of unexpected second foreign bod
ies in children who present to the pediatric emergency department with
esophageal coin impaction. Design/Methods: A retrospective chart revi
ew pediatric patients with esophageal coin impaction who underwent eso
phagoscopy/laryngoscopy for coin removal in a 16-year period at a tert
iary referral center. Data analysis consists of descriptive statistics
. Results: Eighty three of 85 (95%) eligible charts were reviewed. Thr
ee children (3.6%) had unsuspected second foreign bodies: an adherent
penny, a second penny low in the esophagus, and pieces of paper and li
nt. No significant esophageal injury occurred. Conclusions: Unexpected
second foreign bodies in pediatric esophageal coin ingestions with ad
equate radiographic studies are rare and generally do not cause signif
icant esophageal injury.