Dear Dr. Dave and Dr. Dee,
My 2-year-old swallowed a coin recently, and luckily she did not aspirate it. However, she did have trouble getting it all the way down. Her coughing made me rush her to the emergency room fearing a problem with her breathing. The x-ray showed it had gone all the way down. The Doctor said it should pass within a few days, and to watch for vomiting, stomach pains, or distention of the stomach. It has now been 6 days, and she still has not passed the coin. She shows no signs of discomfort, nor is there anything wrong with her stool. What's taking so long?
Should I be concerned?
Dear Should I be concerned,
It's always concerning when a little one swallows a coin. Fortunately, in the vast majority of cases, nature takes its course, and the coin appears in the stool a few days later, without symptoms, although transit time can be surprisingly slow, as you are experiencing.
As your doc probably explained, if a coin is going to hang up somewhere, it's almost always in the esophagus. Esophageal foreign bodies are very symptomatic. If a coin gets stuck high up in the esophagus, close to the airway opening, it often must be removed carefully under anesthesia. Thankfully this is unusual. Most stuck coins lodge in the lower esophagus, or at the sphincter between the esophagus and stomach. Esophageal coins may need to be extracted with an endoscope or, pushed through the lower esophageal sphincter into the stomach.
Fortunately, the need to do any of the above is pretty unusual, since almost all coins make it into the stomach all on their own (as in your child's case). Once in the stomach, the remaining narrowings in the normal gastrointestinal tract are large enough to easily pass the coin, which will show up on inspection of the feces. She should be passing the coin any day now.