Symptoms and spontaneous passage of esophageal coins.

OBJECTIVES: To determine whether coins located in different portions of the esophagus differ in their likelihood of spontaneous clearance, and to determine the frequency of asymptomaticity among children with esophageal coins.

DESIGN: Retrospective case review.

SETTING: Pediatric academic tertiary care center.

PATIENTS: All 73 children presenting in an 18-month period to a pediatric emergency department for coin ingestion whose roentgenographic evaluation revealed an esophageal coin.

INTERVENTIONS: None.

OUTCOME MEASURES: Hospital records of all children were reviewed for demographic information, coin denominations, esophageal locations of ingested coins based on roentgenographic reports, performance of invasive removal procedures, and the presence or absence of signs and/or symptoms.

RESULTS: All of the 58 children with proximal or middle esophageal coins underwent invasive removal procedures, while nine (60%) of 15 distal esophageal coins passed into the stomach spontaneously (P < .001). Five children (7%) were asymptomatic.

CONCLUSIONS: Proximal and middle esophageal coins should be promptly removed, as per present practice. Children with distal esophageal coins should be 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.