Coin ingestion

Case contribution: Dr Radhiana Hassan


  • An 11 months old baby
  • Picked up 10 cent coin and swallowed
  • Witnessed by mother
  • Post ingestion, child cried and vomiting once, milk content vomitus
  • No rapid breathing, no noisy breathing
  • Clinical examination is unremarkable
Chest radiograph AP supine view
Abdominal radiograph in AP supine view

Chest and abdominal radiograph findings:

  • The radiographs show a rounded metallic foreign body overlying the stomach region in keeping with coin as described by mother (yellow arrow)
  • No evidence of intestinal obstruction
  • No pneumoperitoneum to suggest bowel perforation
  • Lungs are clear and normal
  • Thymus shadow is seen, normal at this age group

Diagnosis: Coin ingestion with no obvious complication seen.

Progress of patient:

  • Patient was discharged home
  • Advice to parent to come back if coin not passed within 2 weeks
  • Symptoms of intestinal obstruction also explained and to come again immediately if patient is symptomatic.
  • Patient was well after that, presented again 8 months later with another episode of swallowing foreign body


  • Coins are the most commonly swallowed foreign body that comes for medical attention in children.
  • Most of the ingestion are accidental and children with psychological impairment are at high risk for foreign body ingestion.
  • Most of the time the swallowed coin will harmless pass through the GI tract.
  • The most common site for obstruction is at thoracic inlet, which is area between the clavicles on chest x-ray. Another common site of obstruction is in the mid-esophagus at the level of carina and aortic arch. Lower esophagus at esophageal junction is another site of entrappment.
  • Large object >6cm long and >2cm wide may become entrapped at pylorus
  • High risk for complications of coin ingestion include children with pre-existing gastro-intestinal tract abnormalities such as congenital malformations, neuromuscular disease and eosinophilic esophagitis.
  • X-rays covering the esophagus to beyond pylorus can be done for assessment. If no coin seen or coin seen in stomach or beyond and child looks well, pain-free, no respiratory distress and able to eat or drink, the child can be discharge with advice.
  • Parent may be advised to inspect the stool for foreign body to pass out. Radiographic follow up once a week is sufficient unless patient is symptomatic.
  • Consider referral if child is symptomatic, the coin is seen lodged in esophagus and child has significant past medical history.
Author: radhianahassan