Abstract
Introduction
Foreign body ingestion is a common reason for pediatric emergency department presentation, with coins representing a frequently encountered ingested object. Clinical presentation ranges from being entirely asymptomatic to symptoms such as drooling, dysphagia, cough and chest discomfort. Failure to promptly recognize and appropriately manage an esophageal foreign body may result in serious complications, underscoring the need for a timely diagnosis and management.
Case presentation
We report the case of a 6-year-old boy who presented with drooling and retrosternal pain, approximately 4 h after accidentally swallowing a coin. Plain radiographs demonstrated a round radio-opaque foreign body lodged within the distal esophagus. Following an informed discussion with the parents, instead of immediate endoscopic retrieval, a conservative trial consisting of oral olive oil (1 mL/kg) followed by unrestricted water intake was undertaken. Repeat radiographic evaluation one hour later demonstrated complete passage of the coin beyond the esophagus to the ileocecal region, with complete resolution of the child's symptoms. He was discharged home from the emergency department in a stable condition. The coin was passed spontaneously in the stool within 24 h, without any complications.
Conclusion
This case serves as a hypothesis generating concept of the potential role of oral olive oil as a simple, inexpensive, minimally invasive adjunct for selected cohort of children with coins lodged in the lower esophagus. Such an approach may reduce the need for endoscopic intervention, minimize exposure to anesthesia, shorten emergency department length of stay, reduce rates of admission for endoscopy, and decrease healthcare resource utilization. Nevertheless, patient selection should be done cautiously, with strict adherence to established foreign body ingestion management.