A review of the management of impacted oesophageal coins in children presenting at Dr George Mukhari Hospital

Abstract

Introduction: Ingestion of coins is a common presentation at the emergency departments of hospitals globally. Children are most often the victims of ingesting coins. It requires prompt management of this emergency to prevent complications, as there could be adverse outcomes for the child. Aims of the study: This study was designed to review the management of paediatric patients that presented to the Emergency Department (ED) at Dr George Mukhari Academic Hospital (DGMAH) with impacted oesophageal coins from 01 January 2009 to 31 December 2013. Objectives: To describe the clinical features of paediatric patients who presented to the DGMAH ED with an impacted oesophageal coin and to compare their clinical outcomes based on the method used to extract the foreign body, namely, Foley catheter versus oesophagoscopic technique. Methodology: This was a retrospective transverse descriptive study. Data was collected from the medical records of paediatric patients aged ≤12 years, treated at DGMAH for coin ingestion with oesophageal impaction during the five years from 01 January 2009 to 31 December 2013. A data collection sheet was used to extract relevant data from the medical records. Results: A total of 95 patients (51 females and 44 males) were included in the analysis. The age ranged from 0.70 to 10 years with a median age of 3.0 years. The majority of patients (81.1%) resided in informal settlements. Coins were mostly located in the upper oesophagus (71.6% of cases). The most commonly-impacted coin was a fifty-cent coin (50c); 22mm, which occurred in 23 patients (27.4%). Thirty-five children (42.7%) presented before 8 hours after the ingestion of the coin had elapsed and 47 children (57.3%) presented 8 hours after the coin was ingested. From the 95 patients in the study, 82 patients (86.3%), were asymptomatic. The most commonly-observed signs of oesophageal coin lodgement in the present study were hypersalivation in 17 patients (17.9%) and vomiting in 8 patients (8.4%). The Foley catheter was solely used in 48 patients (77.4%). In this study, the rigid oesophagoscopy was used in 33 patients as first procedure (34.7%). Rigid oesophagoscopy was used in 14 (22.6%) patients following the failure to use Foley’s catheter. The overall success for rigid oesophagoscopy was 100% (44 patients). Conclusion: Coin ingestion is more common in children aged 0–5 years, raised in informal settlements. This study also demonstrated that the Foley catheter seems to offer a safer and effective method in comparison to rigid oesophagoscopy.