Removal of coin from upper esophageal tract in children with Magill's forceps under propofol sedation.

Foreign body ingestion is a common emergency problem in children. Coins are the most common foreign bodies lodged in the esophagus. This is a retrospective study where we reviewed 21 consecutive paediatric cases of coins impacted in the upper esophagus. These children were attended at the BP Koirala Institute of Health Sciences, Dharan, from March 2007 to March 2008. In this study, Mc-Intosh laryngoscopes were inserted into the pharynx to elevate the larynx and to expose the esophageal entrance. Then Magill's forceps were advanced into the esophagus and opened in order to see and extract the coin from the esophagus under propofol sedation. Coins were successfully removed by Magill forceps without any complications from all 21 children. Amongst these children, 14 (66.7%) were male and 7 (33.3%) were female. The mean age of the children was 3.79 (+/- 3.02) years. The coin was grasped and extracted on the first attempt in all 21 patients. The mean time for the removal of the coin (i.e. initiation of laryngoscope to removal of coin) was 51.48 (+/- 24.17) seconds. During direct laryngoscopy, 15 (71.4%) coins were visualized clearly, whereas 6 (28.6%) were not. However all coins were successfully removed. The most commonly ingested coin is a one rupee Nepali coin (42.9%) followed by a two rupee coin (19.0%) and an Indian one rupee coin. Thus it can be seen that the coin impacted at the cricopharynx and upper oesophagus can be safely, easily and quickly removed by direct laryngoscopy and Magill's forceps under propofol sedation.