A common yet potentially serious medical emergency, a coin stuck in the esophagus can cause significant distress and lead to severe complications if not addressed promptly. While often seen in children, adults can also accidentally swallow foreign objects, including coins. Understanding the symptoms, appropriate first aid measures, and available medical treatments is crucial for anyone who suspects a coin stuck in the esophagus. This comprehensive guide will delve into the intricacies of this condition, offering vital information to ensure timely and effective intervention.
Understanding a Coin Stuck in the Esophagus
The esophagus is the muscular tube that connects the throat to the stomach. Its primary function is to transport food and liquids. When a foreign object, such as a coin, becomes lodged in this pathway, it obstructs the normal flow and can irritate or damage the esophageal lining. The severity of the situation largely depends on the size and type of the coin, its exact location, and the duration it remains lodged.
Recognizing the Symptoms of a Coin Stuck in the Esophagus
Identifying the symptoms of a coin stuck in the esophagus is the first step towards seeking appropriate medical care. While some symptoms are immediately obvious, others might be subtle, especially in young children who cannot articulate their discomfort.
Common symptoms include:
- Difficulty Swallowing (Dysphagia): This is perhaps the most prominent symptom. The person may complain of food or even saliva getting “stuck” in their throat. They might refuse to eat or drink.
- Drooling: An inability to swallow saliva effectively leads to excessive drooling, particularly in children.
- Gagging or Choking: While not always a full airway obstruction, the presence of the coin can trigger gagging reflexes or a feeling of something blocking the throat, leading to choking sensations.
- Chest or Neck Pain: The coin’s presence can cause localized pain or discomfort in the chest or neck area, often described as a feeling of pressure or a lump.
- Vomiting: The body’s attempt to dislodge the foreign object can result in vomiting, sometimes bringing up undigested food or fluids.
- Coughing or Wheezing: If the coin is large enough or located in a position that irritates the trachea (windpipe), it can lead to coughing or wheezing, indicating potential airway involvement.
- Irritability or Refusal to Eat (in children): Young children might not be able to verbalize their pain but may become unusually irritable, refuse to eat solid foods, or exhibit signs of discomfort.
- Stridor: A high-pitched, noisy breathing sound, stridor indicates a partial obstruction of the upper airway, which can occur if the coin is pressing on the trachea.
It’s important to note that the absence of severe symptoms does not mean the situation is not serious. Even a seemingly asymptomatic coin stuck in the esophagus still requires immediate medical attention.
First Aid and When to Seek Emergency Help
Knowing when and how to react is critical when dealing with a suspected coin stuck in the esophagus. The immediate response can significantly impact the outcome.
When to Call Emergency Services (911 or your local equivalent):
- If the person is choking and cannot speak, cough, or breathe forcefully: This indicates a complete or near-complete airway obstruction, which is a life-threatening emergency. Do not hesitate; call for immediate medical help.
- If the person becomes unconscious: Loss of consciousness due to choking requires immediate emergency intervention.
First Aid for Choking (Conscious Individual):
For conscious adults and children over one year old, the American Red Cross recommends a sequence of interventions:
1. Encourage Coughing: If the person can cough forcefully, encourage them to continue. A strong cough is often the most effective way to dislodge a foreign object.
2. Back Blows: If coughing is ineffective, administer five back blows. Stand to the side and slightly behind the person. Support their chest with one hand and lean them forward. Deliver five separate, forceful blows with the heel of your hand between their shoulder blades.
3. Abdominal Thrusts (Heimlich Maneuver): If back blows don’t work, perform five abdominal thrusts. Stand behind the person and wrap your arms around their waist. Make a fist with one hand and place it just above the navel, below the rib cage. Grasp your fist with your other hand. Deliver five quick, upward thrusts into the abdomen.
4. Alternate: Continue alternating between five back blows and five abdominal thrusts until the object is expelled or the person becomes unconscious.
- Note: For infants (under one year old), the technique differs and involves back blows and chest thrusts.*
Crucial “Don’ts” When a Coin is Stuck in the Esophagus:
- Do not try to force the object down with food or fluids: This is a common but dangerous misconception. Attempting to push the coin further can lodge it more firmly, cause esophageal damage, or even push it into the airway.
- Never attempt to remove a lodged object yourself unless it’s easily visible and reachable without pushing it further: Blindly probing or trying to pull out a lodged object can cause significant injury to the esophagus, push the coin deeper, or even aspirate it into the lungs.
- Do not induce vomiting: Vomiting can be uncontrolled and may cause the coin to become lodged in the airway during the process.
When to Seek Immediate Medical Advice (Even without Choking):
- If the coin is stuck in the esophagus and not causing choking, you should still seek medical advice immediately. While not an immediate airway emergency, a coin stuck in the esophagus can lead to serious complications if left untreated. Head to the nearest emergency room or urgent care center. Do not wait for symptoms to worsen.
Medical Treatment for a Coin Stuck in the Esophagus
Once medical professionals are involved, they will assess the situation and determine the most appropriate course of action. The primary goal is to safely remove the foreign object and prevent complications.
Diagnostic Procedures:
Before treatment, doctors will typically perform diagnostic tests:
- X-ray: A plain X-ray is usually the first step to confirm the presence, location, and type of the foreign object. Coins are radiopaque and easily visible on X-rays.
- Clinical Examination: A thorough physical examination will be conducted to assess the patient’s overall condition, breathing, and any signs of distress.
Treatment Options:
1. Endoscopic Removal:
* This is often the recommended and most common method for removing lodged objects from the esophagus.
* An endoscope is a thin, flexible tube with a camera and light source attached. It is carefully inserted through the mouth and guided down the esophagus.
* Specialized tools (forceps, baskets, snares) passed through the endoscope are used to grasp and safely remove the coin.
* Endoscopy allows direct visualization of the object and the esophageal lining, enabling precise removal and evaluation for any damage.
* This procedure is typically performed under sedation or general anesthesia, especially in children, to ensure patient comfort and cooperation.
2. Bougienage or Foley Catheter Retrieval (Specific Circumstances):
* According to the American Academy of Family Physicians (AAFP), these methods may be an option for blunt objects like coins, particularly in children, under very specific circumstances.
* Bougienage: This involves gently pushing the object into the stomach using a dilator or bougie. This is generally only considered for small, smooth, blunt objects that are not causing significant distress and are located in the distal (lower) esophagus. The assumption is that once in the stomach, the coin will pass naturally through the digestive tract.
* Foley Catheter Retrieval: A Foley catheter (a flexible tube with an inflatable balloon at the tip) is inserted past the coin. The balloon is then inflated, and the catheter is gently pulled back, bringing the coin with it. This method is usually reserved for objects in the upper esophagus and requires careful technique and monitoring to prevent aspiration.
These methods are less common than endoscopy and are only performed by experienced medical professionals who have carefully assessed the risks and benefits for the individual patient.*
3. Watchful Waiting (Limited Circumstances):
* Watchful waiting may be considered in children with asymptomatic coins lodged in the distal esophagus for less than 24 hours. This means the child is not experiencing any symptoms, and the coin is in the lower part of the esophagus and has been there for a short period.
However, this should only be done under strict medical supervision.* The child’s condition must be closely monitored for any development of symptoms or complications. Repeat X-rays may be performed to track the coin’s movement. If the coin does not pass or symptoms develop, intervention will be necessary. This approach is rarely used for adults due to the higher risk of complications and the fact that adult esophagi are less likely to spontaneously pass a lodged coin.
Risks and Complications Associated with a Coin Stuck in the Esophagus
Leaving a foreign body, especially a coin stuck in the esophagus, can lead to a range of serious and potentially life-threatening complications. This underscores the importance of prompt medical intervention.
Potential risks and complications include:
- Esophageal Perforation: The most severe complication, this is a hole or tear in the wall of the esophagus. It can be caused by the coin itself (if it’s sharp or if the esophagus is irritated) or by attempts to remove it. Perforation can lead to mediastinitis (inflammation of the mediastinum, the space between the lungs), severe infection, and sepsis, requiring emergency surgery.
- Esophagitis: Prolonged presence of a foreign body can cause inflammation and irritation of the esophageal lining. This can lead to pain, difficulty swallowing, and even scarring or stricture formation over time.
- Airway Obstruction or Respiratory Distress: While less common if the coin is strictly in the esophagus, a large coin or one positioned in the upper esophagus can compress the trachea, leading to breathing difficulties, wheezing, stridor, or even complete airway obstruction. Aspiration of saliva or food due to obstruction can also cause respiratory issues.
- Fistula Formation: In rare cases, a prolonged foreign body can lead to the formation of an abnormal connection (fistula) between the esophagus and another organ, such as the trachea (tracheoesophageal fistula) or major blood vessels. This is a very serious complication.
- Mediastinitis: As mentioned, if an esophageal perforation occurs, bacteria and digestive fluids can leak into the mediastinum, causing a severe and life-threatening infection.
- Stricture Formation: Chronic inflammation or damage from a lodged coin can lead to the formation of scar tissue, narrowing the esophagus (stricture), which can cause long-term swallowing difficulties and may require subsequent dilation procedures.
- Pressure Necrosis: The continuous pressure of the coin on the esophageal wall can cut off blood supply to that area, leading to tissue death (necrosis).
Special Considerations for Certain Objects:
While this article focuses on a coin stuck in the esophagus, it’s crucial to highlight two other types of swallowed objects that pose unique and extreme dangers:
- Zinc Pennies (Pennies Minted After 1982): Pennies minted after 1982 have a zinc core coated with copper. If a zinc penny gets stuck in the esophagus, the acidic environment of the esophagus can cause the copper coating to corrode, exposing the zinc. Zinc then reacts with the esophageal lining, leading to a severe chemical burn, rapid tissue damage, and potentially perforation in a very short amount of time. These require immediate and urgent removal.
- Button Batteries: Button batteries (small, disc-shaped batteries found in watches, toys, and remote controls) are incredibly dangerous if swallowed and lodged in the esophagus. They can cause severe liquefaction necrosis (a type of tissue death) within hours due to the electrical current and chemical reaction they produce. This can lead to rapid perforation, hemorrhage, and even death. Button batteries require immediate emergency medical attention and removal, often within two hours of ingestion.
Prevention and Awareness
Preventing foreign body ingestion, especially in children, is paramount.
- Childproofing: Keep small objects, including coins, out of reach of infants and toddlers.
- Supervision: Closely supervise young children during play and meal times.
- Age-Appropriate Toys: Ensure toys are age-appropriate and do not contain small, detachable parts that can be swallowed.
- Educate Children: As children grow, teach them not to put non-food items in their mouths.
- Secure Batteries: Ensure all devices containing button batteries have secure, child-resistant battery compartments.
Conclusion
A coin stuck in the esophagus is a medical emergency that demands prompt attention. Recognizing the symptoms, understanding basic first aid for choking, and knowing when to seek immediate medical help are crucial steps in managing this condition. While endoscopic removal is the most common and effective treatment, alternative methods may be considered in specific scenarios, particularly for children. The potential for severe complications, including esophageal perforation and life-threatening infections, underscores why any suspected foreign body ingestion requires professional medical evaluation without delay. Always remember: if you suspect someone has a coin or any foreign object stuck in their esophagus, seek immediate medical attention. Your quick action can make a life-saving difference.
How to remove a coin from the esophagus?
When the coin remains lodged in the esophagus upper third, the patient is anesthetized and monitored without orotracheal intubation in order to undergo extraction through a straight laryngoscope and long forceps. If that is not possible, the patient is intubated and rigid esophagoscopes may be necessary (Figure 1).
How long can a coin stay in the esophagus?
Unless choking occurs, swallowing a single coin is unlikely to result in death. Coins that are removed from the esophagus within 24 hours of swallowing are not likely to cause permanent tissue damage, but serious internal injuries can occur if coins remain in the esophagus for longer periods of time.
How serious is swallowing a coin?
I can help with that. Children sometimes swallow things such as coins, small toys or beads. Most objects that children swallow are harmless, and are passed through the digestive system and out with the faeces (poo) without any problem. Sometimes, swallowed objects get stuck in the oesophagus (food pipe) and may not pass into the stomach.