Image of the Day 30: Coin Ingestion in 7 months Old Infant

A 7 months old infant alleged ingestion of 5 cents Malaysian coin while reaching it with his hand. He otherwise do not have any respiratory distress. Examination shows a healthy and active infants with normal vital sign. No stridor or other noisy breathing. X ray shows coin inside the esophagus.

Discussion

1. Always obtain a lateral view radiological image to identify the exact location of foreign body. An AP image is usually misleading and not helpful.

2. Esophagus is anatomically posterior to the trachea and usually appears as a ‘collapse’ tube in the lateral neck x ray.

3. Most of the foreign body will enter the gastrointestinal tract rather than airway tract due to protective mechanism of glottis.

4. Always suspect a foreign body ingestion in an infant with capabilities of reaching out object or ambulating who presented with noisy breathing.

5. Foreign body esophagus usually stuck in three normal anatomical narrowing position, 1) Upper esophageal stricture, 2) crossover of the aorta and 3) Lower esophageal stricture.

6. blunt foreign body in gastrointestinal tract can be managed conventionally except for sharp object and multiple magnet ingestion. Serial x ray can be taken based on clinical judgment and it is important that the foreign body already pass the ileo-cecal junction.