Two cases of multiple foreign bodies, i. e., duplex coins in the esophagus are reported. These foreign bodies were removed by peroral esophagoscopy successfully. Significance of roentgen-ray diagnosis is emphasized, and subtle and yet specific roentgenograms of duplex coins
in the esophagus are illustrated.</p

Oguri, Yoshio

Tasaka, Seido

English

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Uncommon cases of foreign bodies in the esophagus--duplex coins

Okayama University Scientific Achievement Repository

Acta Medica OkayamaVolume 24, Issue 4 1970 Article 9AUGUST 1970Uncommon cases of foreign bodies in theesophagus–duplex coinsYoshio Oguri∗ Seido Tasaka†∗Okayama University,†Okayama University,Copyright c©1999 OKAYAMA UNIVERSITY MEDICAL SCHOOL. All rights reserved.Uncommon cases of foreign bodies in theesophagus–duplex coins∗Yoshio Oguri and Seido TasakaAbstractTwo cases of multiple foreign bodies, i. e., duplex coins in the esophagus are reported. Theseforeign bodies were removed by peroral esophagoscopy successfully. Significance of roentgen-ray diagnosis is emphasized, and subtle and yet specific roentgenograms of duplex coins in theesophagus are illustrated.∗PMID: 4254202 [PubMed - indexed for MEDLINE] Copyright c©OKAYAMA UNIVERSITYMEDICAL SCHOOLActa Med. Okayama 24, 483-487 (1970)UNCOMMON CASES OF FOREIGN BODIES IN THEESOPHAGUS- DUPLEX COINS -Yoshio OGURA and Seido TAsAKADepartment oj Oto-Rhino-Laryngology, Okayama University Medical School,Okayama, Japan (Director: Prof. S. Takahara)Received jor publication, June 14, 1970Although a coin is the most common foreign body to become lodgedin the esophagus, its multiple occurrence seems to be rare. We wish torecord two cases of two coins lodged in the esophagus, one in the upperesophagus and the other above the third esophageal constriction.Case l.T. N., a boy, two and a half years old was admitted to the hospitalon July 21, 1965. His mother gave a history of the boy having swalloweda coin one hour before his admission. An attempt to have him cough itout was not successful.Physical Examination: On inspection the child looked pale and appearedto be in slight distress. His breathing was normal. There was no cough.The rest of the examination was within normal limits.Roentgenogram showed a round shadow just below the cricopharyn-geal pinchcock, (Fig. 1). The shadow was coin-sized but slightly elongatedwith some indistinct shadow at the upper and lower edges. This wassuggestive of the possibility of multiple coins, one on top of the other. Alateral projection gave no additional information.Esophagoscopy: Upon esophagoscopic inspection two ten-yen coppercoins were lodged one on top of the other at the site, corresponding tothe X-ray film. The invading objects were tightly impacted in the esopha-geal wall. They were removed one at a time (Fig. 2).Case 2.M. M. An eight-year-old boy was admitted to the hospital on August27, 1965 with a history of having accidentally swallowed coins while play-ing with them in his mouth for two hours prior to his admission. Thehistory given by the family shed no additional light as to the possibilityof multiple foreign bodies.4831Oguri and Tasaka: Uncommon cases of foreign bodies in the esophagus--duplex coinsProduced by The Berkeley Electronic Press, 1970484 Y. OeDRA, and S. TASAKAFig. I Roentgenogram or coin in esophagus, Case I, 2 -§- -year old boy.1em 2Fig. 2 Coins removed out from esophagus of Case I.2Acta Medica Okayama, Vol. 24 [1970], Iss. 4, Art. 9http://escholarship.lib.okayama-u.ac.jp/amo/vol24/iss4/9Uncommon Cases of Foreign Bodies in the Esophagus 485Physical Examination: Normally developed and well-nourished boy.No respiratory distress or cough. All other physical examinations werenormal.Roentgenological Findings: Roentgenogram showed a coin-sized roundshadow a little above the third constriction of the esophagus (Fig. 3). Oncloser inspection this round shadow looked slightly elongated longitudinallywith some fading at the upper and lower edges, much similar to the firstcase. Fluoroscopic examination at various projections failed to give anydefinite diagnostic information of multiple foreign bodies.Fig. 3 Roentgenogram of Case 2, an 8-year old boy.Course and Treatment: The boy was kept in the hospital overnight. Hewas slightly nauseated and vomited once or twice during the night. Fluoro·3Oguri and Tasaka: Uncommon cases of foreign bodies in the esophagus--duplex coinsProduced by The Berkeley Electronic Press, 1970486 Y. OGURA and S. TASAKAscopic study the next morning revealed the foreign body at the same site.Esophagoscopy showed two ten-yen coins lodged above the thirdconstriction. They were grasped with sharp pointed forceps and extractedtogether (Fig. 4). The boy was given antibiotic therapy. Two days laterhe was dismissed with no complications.1cmFig. 4 Two coins taken out from Case 2.COMMENTThe occurrence of multiple foreign bodies of coins is rather rare,though a coin is one of the most common objects encountered in theesophagus, especially in children.In YAMAKAWA's21 years' statistics(l), among which were 420 casesof coins as foreign bodies, there were only four instances of multiple coinoccurrences.In our review of Japanese literature over a 40-year period, there wererecorded only 30 cases of multiple foreign bodies of coins including thepresent ones.SATO (2) recorded a case in which four coins were lodged in one area.This was the largest number listed. IDE (3) reported two cases, each havingmultiple coin esophageal foreign bodies. SASAKI (4) and YAMADA (5) heldthe view that coins rarely lodged at the third esophageal constriction.Thus, our second case was considered rare as to the site of the lodging.No physician can fail to recognize the presence of a coin in theesophageal roentgenogram, but to delineate two objects, such as coins ofthe same size and shape is truly a challenge. These objects tend to sticktogether and the double dimensional projections often fail to indicate theirpresence.Therefore, it should be borne in mind that all foreign body casesshould possibly be multiple, and close and careful evaluation of the roent·genogramsonly may present a clue to the diagnosis.4Acta Medica Okayama, Vol. 24 [1970], Iss. 4, Art. 9http://escholarship.lib.okayama-u.ac.jp/amo/vol24/iss4/9Uncommon Cases of Foreign Bodies in the Esophagus 487In cases of multiple foreign bodies of coin, even though they sticktogether concentrically as in the above mentioned instances, preciselyspeaking, they may not be in complete alignment with each other. Andso, the figure on the roentgenogram looks a little ovaL Moreover, finesight can catch meniscus-shaped indistinctness at the top and bottom ofthe round opacity. IDE (3) and UNGERECHT (8) mentioned it, and thetextbook of ECKERT-MoBIUS (9) is illustrated with such a roentgenogram.SUMMARYTwo cases of multiple foreign bodies, i. e., duplex coins in theesophagus are reported. These foreign bodies were removed by peroralesophagoscopy successfully. Significance of roentgen-ray diagnosis isemphasized, and subtle and yet specific roentgenograms of duplex coinsin the esophagus are illustrated.ACKNOWLEDGEMENTThanks are due to Dr. H. JAMES HARA, Professor Emeritus of Loma Linda Universityat Los Angeles and Dr. S. TAKAHARA, Professor and Chairman of the Department of Oto-Rhino-Laryngology of Okayama University Medical School for painstaking proof-reading ofthis manuscript.REFERENCE1. YAMAKAWA, K.: Foreign body in the esophagus. Nichijibi-Zensho 4 0), 55, 1953 (injapanese)2. SATO, M. et al.: Double foreign bodies in the esophagus (four ten-yen coins.), Jibiinkoka30, 989, 1958 (in japanese)3. IDE, M.: Two cases of double foreign bodies in the esophagus - one, two one-sen coins;the other, three one-sen coins. Jibiinkoka 12, 124, 1939 (in japanese)4. SASAKI, M.: Foreign body in the esophagus. Nichijibi-Zensho 10 (1), 93, 1933 (injapanese)5. YAMAD A, K. et al.: Seven years' statistics of foreign bodies in the air and food passages.J. Japan Bronchoescphagol. Soc. 16, 155, 1965 (in japanese)6. NAKAO, M.: Double foreign bodies in the esophagus-three 50-sen coins. Jibiinkoka 12,128, 1939 (in japanese)7. KOYAMA, H.: Foreign bodies in the esophagus. J. Japan Oto-Rhino-Laryng. Soc. 67, 210,1964 (in japanese)8. UNGERECHT, K.: Ha1s-Nasen-Ohren Heilk. (Berendes-Link-Zollner) Bd. 2, T. 1, S.583,19639. ECKERT-MoBIUS, A.: Lehrbuch der HNO-Heilkunde (2te Aufiage), p. 65, . 196610. JACKSON, C. and JACKSON, C. L.: Bronchoesophagology, p. 256, 19555Oguri and Tasaka: Uncommon cases of foreign bodies in the esophagus--duplex coinsProduced by The Berkeley Electronic Press, 1970

Double foreign bodies in the esophagus-three 50-sen coins.

et al.: Double foreign bodies in the esophagus (four ten-yen coins.),

et al.: Seven years' statistics of foreign bodies in the air and food passages.

Foreign bodies in the esophagus.

Foreign body in the esophagus.

Ha1s-Nasen-Ohren Heilk.

Lehrbuch der HNO-Heilkunde (2te Aufiage),

Oguri and Tasaka: Uncommon cases of foreign bodies in the esophagus--duplex coins Produced by The Berkeley Electronic Press,

Two cases of double foreign bodies in the esophagus - one, two one-sen coins; the other, three one-sen coins.

Uncommon cases of foreign bodies in the esophagus--duplex coins

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