CASE
An 88-year-old man was transferred by ambulance with hypotension and
impaired consciousness. X-ray showed a radiolucent area around the
mediastinum and a coin in the stomach (Figure 1 ). Computed
tomography imaging revealed mediastinal emphysema and a hyperintense
gastric foreign body (Figure 2A, 2B ). The patient was diagnosed
with septic shock due to esophageal perforation by accidental ingestion
of coins and subsequent mediastinitis. The patient was managed with
antibiotics and esophageal drainage, and his physical condition showed
improvement. On day 25, the patient developed hemorrhagic gastric ulcer
after prolonged fasting, and endoscopic clipping was performed in the
pyloric region. Two coins (22.6 mm diameter) were removed from the
gastric body region (Figure 3A, 3B ). After the hemostasis and
transfusion, he developed aspiration pneumonia and acute respiratory
distress syndrome, then passed away on day 34.
Coins are one of the most common esophageal foreign bodies in adults and
it is usually expected spontaneous passing safely. Esophageal
perforation due to foreign bodies is rare at 0.91%1.
While esophageal injuries after sharp edges ingestion, including fish
bones and press-through-packs, are often experienced, perforation after
rounded-shape coin ingestion is rarely reported.2 Even
foreign bodies considered unlikely to injure the esophagus may cause
perforation and lead to a critical course.