Kids eat up your money in more ways than one. Some may eat it up in the form of $50,000 a year in college tuition and some eat it up as a meal. For coins that get stuck in the esophagus the American Society for Gastrointestinal Endoscopy recommends watching asymptomatic patients for a period of 24 hours prior to any intervention. Once the coins passes into the stomach most will traverse the GI tract without any complication. There are multiple different methods of retrieving coins that are lodged in the esophagus: endoscopy, foley catheter technique, glucagon and bougienage is a method of pushing the coin into the stomach. Classically, you use a Hurst dilator (or build your own) and advance it down the child’s esophagus to push the coin past the lower esophageal sphincter (step-by-step instructions). Bougienage, when used on appropriate patients, is a safe modality for treating esophageal coins with only minor complications reported. Some have reported success rates as high as 95%; however, you have to stick to the following inclusion criteria:
- Witnessed ingestion
- Foreign body is a coin
- Coin is seen in the esophagus on x-ray
- Single coin is present
- Ingestion < 24 hrs
- No previous esophagus procedure or pathology
- No respiratory symptoms
- Performed by trained personnel
If you successfully get the coin to pass into the stomach then the patient can be discharged home. If the piggy bank doesn’t give up the coin in the next 2 weeks, then the patient will need a repeat xray to see where it is. Check out this ACEP Now article for a more detailed discussion of bougienage.
Post by: Terrance McGovern DO, MPH (@drtmcg13)