Pediatr Emerg Med J.  2021 Dec;8(2):116-119. 10.22470/pemj.2021.00283.

A case of stacked coin ingestion mistaken for button battery

• Kim SR
• Park JS
• Oh SH
• Lee JY

• KMID: 2524006
• DOI: http://doi.org/10.22470/pemj.2021.00283

Abstract

Button battery ingestion requires emergency endoscopic removal since severe complications, such as esophageal perforation, can develop within 4 hours of the ingestion. Given that guardians do not witness the children’s foreign body ingestion 40% of the time, physicians can only guess what was swallowed based on plain radiography. We report a case of a 45-month-old-boy who visited the emergency department after swallowing an unknown foreign body and whose radiographs showed “circle-within-a-circle appearance” on the anteroposterior view and “step-off appearance” on the lateral view, suggesting button battery ingestion. We conducted emergency endoscopic removal, and found stacked coins mimicking a button battery on the radiographs. The coins were pushed into the stomach and came out through defecation 3 weeks later without further complications. Distinguishing between stacked coins and a button battery through radiography may help avoid unnecessary emergency endoscopy.

Keyword

Child; Esophagus; Foreign Bodies; Numismatics; X-Rays

Figure

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  Fig. 1. Findings of the foreign body on neck radiographs, suggesting the presence of a button battery in the esophagus. (A) The anteroposterior view shows “circle-within-a-circle appearance (also known as ‘double-ring shadow’; arrow in thumbnail A).” The diameter of 26.5 mm coincides with that of 500 Korean Won coin. (B) The lateral view shows “step-off appearance (arrow in thumbnail B).”

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  Fig. 2. Endoscopic finding. The 2 coins, 100 and 500 Korean Won, were located in the upper esophagus. These stacked coins radiographically mimicked a button battery.

Reference

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