title: A case of mistaken identity: accidental ingestion of coins causing esophageal impaction in an elderly female.
abstract: Coin impaction of the esophagus is infrequently seen in adults, and multiple coin impaction has not been described. The patient was an 85-year-old blind female who presented with 2 days of dysphagia and odynophagia following an attempt to take her medications at bedtime. She reported an esophageal injury from endotracheal intubation during a surgery 6 months earlier. Radiographs showed a radiopaque circular mass in the midesophagus. Endoscopy showed 3 US coins--a nickel, a dime, and a penny--stacked together and impacted on a stricture at 27 cm from the gums. An overtube was planned, but preplacement evaluation showed the lumen was smaller than the coin diameters. An attempt with a retrieval net was unsuccessful. The patient then underwent endotracheal intubation and the coins were removed individually with rat-tooth foreign body forceps. She recovered and underwent successful endoscopic dilation 3 weeks later. She remains asymptomatic since dilation. A brief review of coin impaction and endoscopic management is discussed. Endotracheal intubation for airway protection during endoscopy is recommended for these patients.
authors: Gastroenterology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia, USA. keithfincher@comcast.net
authors: Roger Keith
authors: RK
authors: Fincher
authors: Eric M
authors: EM
authors: Osgard
mesh_terms: D000061:Accidents, Home; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D009717:Numismatics; D016896:Treatment Outcome