A one-year-old boy presented to the emergency department after his parents observed the patient had swallowed a one New Taiwan Dollar two hours ago. He had sore throat and vomited once prior to ER arrival. Physical examination showed clear breathing sound without difficulty swallowing nor abdominal tenderness. Vital signs revealed a temperature of 37.6°C, blood pressure of 91/67 mm Hg, pulse rate of 130 beats/min, respiratory rate of 24 breaths/min, and oxygen saturation of 98% on room air. A radiograph of the chest showed a coin-shaped foreign body in the neck (Figure 1). Otolaryngologist was consulted. Given that the diameter of the one-dollar coin is 2 cm, which is larger than that of the trachea of a one-year-old boy, the chance of foreign body aspiration in the respiratory tract is rare. Lateral view x-ray showed a foreign body was located in the esophagus (Figure 2).

Figure 1: Neck radiograph showed a coin-shaped foreign body in the neck.

Figure 2: Lateral view radiograph revealing a coin-shaped foreign body located in the esophagus.

Ingested items that warrant immediate endoscopic removal from the esophagus include button batteries and sharp objects [1, 2]. The case was termed “simple” if there was a single coin, if it was present for less than 24 hours, if the child had minimal or no symptoms, and if there was no underlying esophageal pathology. Observation and re-evaluation upon admission were suggested. Feeding was initiated and the patient showed no symptoms of airway compression from the esophageal foreign body, including epiglottis, croup, and asthma, nonspecific vomiting, or feeding abnormalities [1, 2]. His appetite and activity level were as usual. Follow-up x-ray revealed that the single esophageal coin spontaneously passed to the sigmoid colon (Figure 3). The patient recovered well and was discharged home. Upon outpatient follow-up visit, there was no foreign body shown in the plain film.

Figure 3: Abdominal radiograph demonstrating the single coin-shaped foreign body spontaneously passed to the sigmoid colon.

1. Malik SA, Qureshi IA, Muhammad R. Diagnostic Accuracy Of Plain X-Ray Lateral Neck In The Diagnosis Of Cervical Esophageal Foreign Bodies Keeping Oesophagoscopy As Gold Standard. J Ayub Med Coll Abbottabad. 2018; 30: 386-388.
2. Kim JK, Kim SS, Kim JI, Kim SW, Yang YS, Cho SH, et al. Management of foreign bodies in the gastrointestinal tract: an analysis of 104 cases in children. Endoscopy. 1999; 31: 302-304.