Complications and costs may be reduced by spontaneous passage of
coins ingested by children
Boston - More than 3,500 incidences of children ingesting coins were reported to poison centers in 1996, with as many as 17 percent of the coins becoming lodged in the esophagus.
At Boston's Children's Hospital, patients with single esophageal coins diagnosed within 24 hours of ingestion and with no history of esophageal disease, have a 28 percent chance of spontaneously passing the coin into the stomach within 12 hours. Allowing for spontaneous passage, rather than performing more invasive procedures, may reduce related complications and reduce institutional costs.
The study was performed by Joyce V. Soprano, M.D., Gary R. Fleisher, M.D., and Kenneth D. Mandl, M.D., M.P.H. of Boston's Children's Hospital Division of Emergency Services, who reviewed, over a 24-month period, medical records and radiographs of patients with coins lodged in their esophagus. Independent measures were the time between ingestion and radiographs, location of coin, and categorization of case as uncomplicated or complicated. Uncomplicated cases were defined as those patients with no prior history of esophageal disease or surgery, with a single esophageal coin lodged for fewer than twenty-four hours, and with no respiratory compromise on presentation.
The results indicated that of 116 total cases, 84 were uncomplicated and 32 were complicated. Spontaneous passage occurred in none of the complicated cases. Of the uncomplicated cases, spontaneous passage occurred in 28 percent, and even proximally located coins, which previously have been thought unlikely to pass spontaneously, have a 22 percent chance of spontaneous passage.
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