A 10-year-old boy swallowed a Canadian dollar (“Loonie”) almost 12 hours ago. He complains of difficulty swallowing solids, but not liquids. Chest radiograph shows a round, flat, metallic object at the level of the aortic arch. He has no respiratory difficulty. At this point, you should:
Extract the coin using a Foley catheter.
+Perform imaging study using a water-soluble contrast agent, followed by extraction of the foreign body with a Foley catheter.
+Extract the coin using a Foley catheter, then follow with a barium swallow to rule out esophageal injury.
+Arrange immediate endoscopic consultation.
+Discharge home and instruct the parents to observe for passage of the coin.
This esophageal foreign body has not progressed distally for several hours. A contrast study is unnecessary, as the chest radiograph has identified the foreign body and its location. Passing the distal tip of a balloon-tipped catheter past the foreign body, inflating the balloon, and then trying to pry the foreign body proximally carries the risk of aspiration and perforation. Endoscopy is the best method for removal of esophageal foreign bodies.