Wednesday, April 22, 2015

A 5 year old child swallowed a coin - now in stomach on X ray - what to do?

Q: A 5year old boy has just been rushed to my OPD with a swallowed coin. The child is playful & active, and the coin was swallowed 1-2 hours back. An xray reveals that the coin has reached the stomach. How to proceed?

Guest Answer - Posted at Docpelxus by Dr Kirthy Proamd R.
Coin ingestion in children is very common. Most paediatric surgeons at institutions see atleast around twenty coin ingestions a year. They all pass out in the stool. There is no necessity to give laxatives too, as this can cause the FB(foreign body to get stuck at some kink in the bowel. If an ingested coin remains in the stomach for more than 72 hrs in an xray, then u may consider endoscopic extraction. many ppl even wait upto seven days for spontaneous passage in stool. ofcourse parents need to check the stool for passage of FB, so as to avoid unnecessary xrays. urgent removal of coin is necessary when its stuck in esophagus and causing retching. many occasions when a coin is stuck in the esophagus and child is ASYMPTOMATIC, overnight waiting for it to spontaneously pass to stomach and confirming on xray is sufficient as it then passes out.
Most foreign bodies pass out on their own... seen large clips(hair clips-even fla ones) triangular glass pieces, lockets, safety pins all come out on their own.
In sharp foreign bodies dangerous is foreign bodies with both ends sharp.. like a needle...
one edge pointed and other broad end objects do not cause problem...courtesy fluid dynamics...when the flowing liquid has to take a foreign body along, its always the broad end that moves forward...physics...
in non-sharp foreign bodies... dangerous is button batteries.... try n get them out as quickly as possible... endoscopy or paeglec flush therapy in hospital... this is because the button-battery has a rubber seal holding the the metalic round plates together with dangerous chemicals like mercuric chloride inside... the older the battery the faster the rubber ring melts in the gastric acid and chance for the the button battery to open up and cause havoc of multiple perforations in the intestines.....
Magnets also may come out many times if small but sometimes there is a risk of two powerful pieces of magnet getting attracted through different bowel loops and then causing slow necrosis of intervening bowel walls.. seen one case
So most often it is just "Masterly Inaction and Careful Follow-up"
Sorry if this is little exhaustive to your question.... but sure will help u get an overview
Seen all these personally during my training under my teachers and my practice of Paediatric Surgery in the last ten years
Thank you

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