Zm Raahat, Nusrat Raza, Adnan Saleem Umar, Syed Shaukat Hussain, Ajmal Rasheed, Zahid Akhtar Rao.
Coin Impaction at Upper end of Esophagus; Wait or Intervene.
Pak J Otolaryngol Jan ;29(3):77-9.

OBJECTIVE : To document logical management of coin impaction at upper end of esophagus. STUDY DESIGN: Prospective, observational. PLACE & DURATION OF STUDY. This study was done in two centers, PNS Shifa, Karachi and Combined Military hospital Quetta from August 2009 to December 2010. PATIENTS AND METHODS: 83 children with history of coin impaction at upper end of esophagus were included after radiological evidence of impaction at upper end of esophagus. Rigid endoscopy under general anesthesia was planned in every case. Prior to endoscopy, base line investigations done and patients were kept nil by mouth for six hours. Just before endoscopic intervention repeat Xray neck & chest was done in every patient to see the latest location of impacted coin. RESULTS: There were 53 boys and 30 girls. Age varied between 2 to 6 years. Five rupee coins impacted in 37(44.57%), two rupee coin in 24(28.91%) and one rupee coin in 22(26.50%). Size of five rupee coin in millimeters is 25, two rupee coin 22 mm and one rupee coin is 20 mm. 4 five rupee coins, 9 two rupee coins and 15 one rupee coins spontaneously passed from esophagus to stomach within 06 hours. CONCLUSION: Chances of coin impaction is directly proportional to its size and inversely with the age of child. An impacted coin, 20 mm or below in size must be given a chance for at least 6 hours to pass spontaneously.

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