intllan .7. Pla'l,ttr. 46 t 108, 197t
COIN RETAINED IN THE OESOPHAGUS FOR SIX M O N T H S * A. M^JID, A.K. LAHIRI AND Y.K. MARU New Delhi R e p o r t o f Case A female child aged 7 years was admitted on 7th November t977 to the paedlatric surgical ward with the complaints o f d y s p h a g i a to solids and repeated vomiting for the previous six months. T h e child looked emaciated but there was nothing significant on examination of the oral cavity, pharynx and larynx. X-ray o f the chest showed a radio-opaque rounded foreign body a t the level of T3-4 (Plate I, Fig. 1). T h e parents, when questioned, recollected the child having swallowed a fifty paisa coin six months previously. At the time, the attending physician had treated her on conservative lines, with some relief o f the dysphagia and she was sent home on the presumption that the coin had pasted out. She, however, had repeated episodes of vomiting since then, for which various antiemetic, antispasmodic and antacid preparations were prescribed, but at no stage was X-ray of the chest done. Management T h e patient was referred to us for removal o f the foreign body. Under general anasthesia oesophagoscopy was performed. A metallic foreign body was visible, lying transeversely in the lumen, flushed with the posterior wall of the oesophagus. With some manipulation, a black, rusted fifty From the Department of E.N.T., Maulana Azad Medical College and A~ciated Lok Nayak Jai ]FrakashNaraiu and Gobind Ballabh Pant Hospitals, New Delhi-ll0b02. Received May, 1, 1978.
paisa coin was taken out. There occurred minimal bleeding from the oedematou# mucosa. The post-operativecourse was uneventful. She resumed her normal diet and gained weight. Discussion While recently lodged foreign bodies are numexom, cases of neglected foreign bodies are much less common in the ~allet. The retained foreign body is more likely to produce fatal complications in the long run. T h e local pathological changes which can occur in such neglected cases depend upon the nature of the foreign body. Coins are regarded as the least traumatising. However, in long standing cases certain chemical changes occur due to formation of various oxides and sulphides. Such compounds produce localised irritation and hence set up an inflammatory process which may proceed to a fatal end. T h e case once again emphasizes the point that in all children presenting with dysphagia and frequent vomiting, the possibility of a foreign body in the upper food passage should be kept in mind and they should be carefully investigated. Improper attentiort by tke attending .physician to such problems should be of great concern to the patient. We thank the College and Medical Superintendent, L.N..J.P. Hospital, New Delhi, for allowing us to publish this case report. We are also thanklul to Mr. Ravi Kant Bhalla for his excellent typing.
INDIAN JOU~tN~L OF PEDIATRIC8
PLATE
Fig. I.
X-ray of chest showing foreign body at level T 3.4.
MAJID ET AL.--NEGLECTED COIN IN THE OESOPHAGUS.
I
COIN RETAINED IN THE OESOPHAGUS FOR SIX M O N T H S * A. M^JID, A.K. LAHIRI AND Y.K. MARU New Delhi R e p o r t o f Case A female child aged 7 years was admitted on 7th November t977 to the paedlatric surgical ward with the complaints o f d y s p h a g i a to solids and repeated vomiting for the previous six months. T h e child looked emaciated but there was nothing significant on examination of the oral cavity, pharynx and larynx. X-ray o f the chest showed a radio-opaque rounded foreign body a t the level of T3-4 (Plate I, Fig. 1). T h e parents, when questioned, recollected the child having swallowed a fifty paisa coin six months previously. At the time, the attending physician had treated her on conservative lines, with some relief o f the dysphagia and she was sent home on the presumption that the coin had pasted out. She, however, had repeated episodes of vomiting since then, for which various antiemetic, antispasmodic and antacid preparations were prescribed, but at no stage was X-ray of the chest done. Management T h e patient was referred to us for removal o f the foreign body. Under general anasthesia oesophagoscopy was performed. A metallic foreign body was visible, lying transeversely in the lumen, flushed with the posterior wall of the oesophagus. With some manipulation, a black, rusted fifty From the Department of E.N.T., Maulana Azad Medical College and A~ciated Lok Nayak Jai ]FrakashNaraiu and Gobind Ballabh Pant Hospitals, New Delhi-ll0b02. Received May, 1, 1978.
paisa coin was taken out. There occurred minimal bleeding from the oedematou# mucosa. The post-operativecourse was uneventful. She resumed her normal diet and gained weight. Discussion While recently lodged foreign bodies are numexom, cases of neglected foreign bodies are much less common in the ~allet. The retained foreign body is more likely to produce fatal complications in the long run. T h e local pathological changes which can occur in such neglected cases depend upon the nature of the foreign body. Coins are regarded as the least traumatising. However, in long standing cases certain chemical changes occur due to formation of various oxides and sulphides. Such compounds produce localised irritation and hence set up an inflammatory process which may proceed to a fatal end. T h e case once again emphasizes the point that in all children presenting with dysphagia and frequent vomiting, the possibility of a foreign body in the upper food passage should be kept in mind and they should be carefully investigated. Improper attentiort by tke attending .physician to such problems should be of great concern to the patient. We thank the College and Medical Superintendent, L.N..J.P. Hospital, New Delhi, for allowing us to publish this case report. We are also thanklul to Mr. Ravi Kant Bhalla for his excellent typing.
INDIAN JOU~tN~L OF PEDIATRIC8
PLATE
Fig. I.
X-ray of chest showing foreign body at level T 3.4.
MAJID ET AL.--NEGLECTED COIN IN THE OESOPHAGUS.
I
