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The removal of coins from the upper esophageal tract of children by emergency physicians: a pilot study

Published online by Cambridge University Press:  21 May 2015

Edward J. Vargas ,
Ameer P. Mody ,
Tommy Y. Kim ,
T. Kent Denmark ,
James A. Moynihan ,
Besh B. Barcega ,
Aqeel Khan ,
Robin T. Clark  and
Lance Brown
Edward J. Vargas
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Ameer P. Mody
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Tommy Y. Kim
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
T. Kent Denmark
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
James A. Moynihan
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Besh B. Barcega
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Aqeel Khan
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Robin T. Clark
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Lance Brown*
Affiliation:
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
*
Division of Pediatric Emergency Medicine, Department of Emergency Medicine, A-108, Loma Linda University Medical Center and Children’s Hospital, 11234 Anderson St., Loma Linda CA 92354; fax 909 558-0121, LBROWNMD@aol.com

Abstract:

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Objective:

There are few reports in the medical literature describing removal of a coin from the upper esophageal tract of a child by an emergency physician. However, given the nature of their training and practice, emergency physicians are well suited to perform this common procedure. We describe our experience with this procedure.

Methods:

This was a retrospective review of a continuous quality improvement data set from a university-based tertiary care pediatric emergency department between Nov. 1, 2003, and Mar. 31, 2004.

Results:

Thirteen children, with a median age of 20 months, underwent rapid sequence intubation and had coins successfully removed from their upper esophageal tract by emergency physicians. In 10 cases, the coin was visible at laryngoscopy and removed with Magill forceps. In 3 cases this approach failed and a Foley catheter was used to remove the coin. One child suffered a tonsillar abrasion and two sustained minor lip trauma, but all were extubated and discharged home from the emergency department with no significant complications. Eleven of the 13 patients were successfully followed up, and the parents reported no problems.

Conclusions:

This pilot study suggests that the removal of a coin from the upper esophageal tract by an emergency physician can be both safe and effective. A larger study is needed before this procedure can be generally recommended.

Keywords

foreign bodyairwayintubationsedationprocedure
Type
Pediatric Em • Pédiatrie D’urgence
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 6 , November 2004 , pp. 434 - 440
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Conners, GP, Chamberlain, JM, Weiner, PR.Pediatric coin ingestion: a home-based survey. Am J Emerg Med 1995;13:638–40.CrossRefGoogle ScholarPubMed
2.Shah, MK, Lim, YC.A case of tracheal obstruction during oesophageal removal of a foreign body. Singapore Med J 1997;38:120–2.Google Scholar
3.Uba, AF, Sowande, AO, Amusa, YB, Ogundoyin, OO, Chinda, JY, Adeyemo, AO, et al. Management of oesophagal foreign bodies in children. East Afr Med J 2002;79:334–8.CrossRefGoogle ScholarPubMed
4.Schloss, MD, Terraza, O.Introduction of a Canadian dollar coin has created a new health hazard for children. J Otolaryngol 1993;22:428–30.Google ScholarPubMed
5.Cheng, W, Tam, PKH.Foreign-body ingestion in children: experience with 1,265 cases. J Pediatr Surg 1999;34:1472–6.Google Scholar
6.Soprano, JV, Fleisher, GR, Mandl, KD.The spontaneous passage of esophageal coins in children. Arch Pediatr Adolesc Med 1999;153:1073–6.Google Scholar
7.Hostetler, MA, Barnard, JA.Removal of esophageal foreign bodies in the pediatric ED: Is ketamine an option? Am J Emerg Med 2002;20:96–8.Google Scholar
8.Conners, GP, Chamberlain, JM, Ochsenschlager, DW.Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med 1995;149:36–9.CrossRefGoogle ScholarPubMed
9.Mahafza, TM.Extracting coins from the upper end of the esophagus using a Magill forceps technique. Int J Pediatr Otorhinolaryngol 2002;62:37–9.CrossRefGoogle ScholarPubMed
10.Schunk, JE, Harrison, M, Corneli, HM, Nixon, GW.Fluoroscopic Foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes. Pediatrics 1994;94:709–14.CrossRefGoogle ScholarPubMed
11.Nandi, P, Ong, GB.Foreign body in the oesophagus: review of 2394 cases. Br J Surg 1978;65:5–9.Google Scholar
12.Sharieff, GQ, Brousseau, TJ, Bradshaw, JA, Shad, JA.Acute esophageal coin ingestions: Is immediate removal necessary? Pediatr Radiol 2003;33:859–63.Google Scholar
13.Macpherson, RI, Hill, JG, Othersen, HB, Tagge, EP, Smith, CD.Esophageal foreign bodies in children: diagnosis, treatment, and complications AJR Am J Roentgenol 1996;166:919–24.Google Scholar
14.Schunk, JE, Corneli, H, Bolte, R.Pediatric coin ingestions: a prospective study of coin location and symptoms. AJDC 1989;143:546–8.Google Scholar
15.Nahman, BJ, Mueller, CF.Asymptomatic esophageal perforation by a coin in a child. Ann Emerg Med 1984;13:627–9.Google Scholar
16.Janik, JE, Janik, JS.Magill forceps extraction of upper esophageal coins. J Pediatr Surg 2003;38:227–9.Google Scholar
17.Tucker, JG, Kim, HH, Lucas, W.Esophageal perforation caused by coin ingestion. South Med J 1994;89:269–72.CrossRefGoogle Scholar
18.Burton, DM, Stith, JA.Extraluminal esophageal coin erosion in children: case report and review. Int J Pediatr Otorhinolaryngol 1992;223:187–94.CrossRefGoogle Scholar
19.Pasquariello, PS, Kean, H.Cyanosis from a foreign body in the esophagus. Clin Pediatr 1975;14:223–5.Google Scholar
20.Obiako, MN.Tracheoesophageal fistula. A complication of foreign body. Ann Otol Rhino Larygol 1982;91:325–7.Google Scholar
21.Vella, EE, Booth, PJ.Foreign body in the oesophagus. Br Med J 1965;2:1042.Google Scholar
22.Bonadio, WA, Emslander, H, Milner, D, Johnson, L.Esophageal mucosal changes in children with an acutely ingested coin lodged in the esophagus. Pediatr Emerg Care 1994;10:333–4.Google Scholar
23.Dunlap, LB.Removal of an esophageal foreign body sing a Foley catheter. Ann Emerg Med 1981;10:101–3.CrossRefGoogle Scholar
24.Mason, SM.Pharyngeal coin removal in children. J Accid Emserg Med 1997;14:175–6.CrossRefGoogle ScholarPubMed
25.al-Shahi, R, O’Connell, M, Huchzermeyer, P, Moore-Gillon, V.Combined forceps and catheter extraction of an oesophageal foreign body. J Laryngol Otol 1997;111:583–4.Google Scholar
26.Calkins, CM, Christians, KK, Sell, LL.Cost analysis in the management of esophageal coins: Endoscopy versus bougienage. J Pediatr Surg 1999;34:412–4.Google Scholar
27.Conners, GP.A literature-based comparison of three methods of pediatric esophageal coin removal. Pediatr Emerg Care 1997;13:154–7.CrossRefGoogle ScholarPubMed
28.Emslander, HC, Bonadio, W, Klatzo, M.Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion. Ann Emerg Med 1996;27:726–9.CrossRefGoogle ScholarPubMed
29.Sagarin, MJ, Chiang, V, Sakles, JC, Barton, ED, Wolfe, RE, Vissers, RJ, et al. Rapid sequence intubation for pediatric emergency airway management. Pediatr Emerg Care 2002;18:417–23.Google Scholar
30.Rubio Quinones, F, Munoz Saez, M, Povatos Serrano, EM, Hernandez Gonzalez, A, Quintero Otero, S, Pantoja Rosso, S.Magill forceps: a vital forceps. Pediatr Emerg Care 1995;11:302–3.CrossRefGoogle ScholarPubMed
31.Brown, L, Denmark, TK, Wittlake, WA, Vargas, EJ, Watson, T, Crabb, J.Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies. Am J Emerg Med 2004; 22:310–4.Google Scholar