Infants put almost everything into their mouths and toddlers eat just about anything. The majority of foreign body ingestions occur in children between the ages of six months and three years [1]. Only 10 to 20 percent of foreign bodies require endoscopic removal, and less than 1 percent require surgical intervention [1,2].

Fig. 1 X-ray chest PA and Lateral view showing radio-opaque foreign body.

Retained foreign body in esophagus is very rare presentation, which may damage the mucosa leading to stricture or fistula. We report a case of 8-yr-old male child who was brought to medical attention with complaints of vomiting after meals and difficulty in swallowing food for the past 4 years, along with cough and noisy breathing for three months. There was a history of ingestion of a 2-rupee coin prior to start of the symptoms, passage of which the parents never noticed subsequently in stools, and they did not seek any further medical attention. After admission, X-ray chest was done which revealed a radio-opaque shadow in the mid esophagus; lungs were normal (Fig. 1). Upper gastrointestinal endoscopy revealed a stricture at 12 cm from incisors; proximal esophagus showed diverticulum and the coin was seen distal to the stricture. The stricture was dilated using Savory Gillard dilators and the coin was pushed distally into the stomach. (Fig 2). A contrast X-ray swallow (gastrograffin) study was normal. After one week, the child passed the coin in the stool. Repeat dilatation was done after 7 days and 21 days. After dilatation, the child started accepting feeds orally without any complaints; there was no requirement of dilatation after three initial sessions.

Fig. 2 Stricture and diverticulum in esophagus.

Retained esophageal foreign bodies are uncommon in pediatric practice and they should be endoscopically removed as soon as possible. In our patient, the appropriate management for coin ingestion was not done at the time of ingestion and thus led to retained foreign body and stricture formation. Esophageal stricture resulting from a long-standing lodgment of metallic foreign bodies has been reported earlier [3,4]. As retained esophageal foreign body can lead to stricture, a timely appropriate management should be done at the time of ingestion.

1. Wyllie R. Foreign bodies in the gastrointestinal tract. Curr Opin Pediatr. 2006; 18:563.

2. Uyemura MC. Foreign body ingestion in children. Am Fam Physician. 2005; 72:287.

3. Doolin EJ. Esophageal stricture: An uncommon complication of foreign bodies. Ann Otol Rhinol Laryngol. 1993;102:863-6.