Fluoroscopic Removal of Ingested Foreign Body

Foreign body ingestion, typically coins, is a frequent cause of pediatric emergency room visits. The coin is often stuck in the esophagus, and children will present with symptoms of food refusal and inability to handle oral secretions. Historically, removal necessitated endoscopic retrieval under a general anesthetic in the operating room.

At Children's Mercy, we use a fluoroscopic approach, which obviates the need for anesthesia or sedation. The patient is brought to the fluoroscopy suite, where a rubber catheter is placed past the obstructing coin. The coin is then dislodged and brought up into the mouth, where the child can cough out the coin, better known as the "coin flip." Patients can be discharged from the emergency room soon after without need for an admission.

In a retrospective review of more than 800 patients over the last 30 years, the success of fluoroscopic retrieval was 85.5%. All remaining coins were able to be retrieved by endoscopy. Those who were able to have the coin successfully retrieved by using the coin flip procedure spent a median of 3.2 hours in the hospital, compared to 18.1 hours for those who required endoscopic retrieval. The overall complication rate was low, at 1.2%, with most complications being minor in nature, such as epistaxis (nosebleed) and vomiting. Thus, we were able to show that use of the coin flip procedure resulted in lower lengths of stay without the need for a general anesthetic.

Read the publication on 30 years of retrieving coins using the “coin flip” method.