A Case of Mistaken Identity: Accidental Ingestion of Coins Causing Esophageal Impaction in an Elderly Female

Roger Keith Fincher, MD, Eric M. Osgard, MD

Disclosures

June 06, 2003

Abstract and Introduction

Coin impaction of the esophagus is infrequently seen in adults, and multiple coin impaction has not been described. The patient was an 85-year-old blind female who presented with 2 days of dysphagia and odynophagia following an attempt to take her medications at bedtime. She reported an esophageal injury from endotracheal intubation during a surgery 6 months earlier. Radiographs showed a radiopaque circular mass in the midesophagus. Endoscopy showed 3 US coins-- a nickel, a dime, and a penny-- stacked together and impacted on a stricture at 27 cm from the gums. An overtube was planned, but preplacement evaluation showed the lumen was smaller than the coin diameters. An attempt with a retrieval net was unsuccessful. The patient then underwent endotracheal intubation and the coins were removed individually with rat-tooth foreign body forceps. She recovered and underwent successful endoscopic dilation 3 weeks later. She remains asymptomatic since dilation. A brief review of coin impaction and endoscopic management is discussed. Endotracheal intubation for airway protection during endoscopy is recommended for these patients.

Coin ingestion is a common occurrence in both adults and children.[1,2,3] In children, impaction or obstruction from coin ingestion commonly occurs and typically is located in the esophagus. Coin ingestion in adults is associated with drinking games, drug or alcohol use, or mental illness.[1,4] It does not lead to impaction or intestinal obstruction in adults unless some structural abnormality exists or the coin is unusually large.[1,2,4] Such ingestions are usually single coin ingestions. We describe an elderly patient who accidentally ingested 3 coins, leading to esophageal impaction.

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