Push down a coin stuck in throat

When a child swallows a coin and it gets stuck in the throat, it is safe for doctors to push it down into the stomach rather than trying to pull it out. The procedure to push a swallowed coin, stuck in the throat, down into the digestive tract, so that it can be passed out in the natural course of events is called bougienage. A “bougie” is a thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the oesophagus, to widen the passageway, guide another instrument into a passageway, or dislodge an object. Someone trained in the procedure can insert and withdraw the bougie in 5 seconds or less. No anaesthesia is necessary, other than perhaps an anaesthetic spray applied to the back of the child's throat. In many cases, however, an endoscope is inserted into the throat in an effort to grasp the coin and pull it up. Endoscopy in these circumstances is performed under general anaesthesia in the operating room. To compare the safety and effectiveness of these procedures, American researchers assessed the outcomes of 620 patients who were treated over a period of 12 years at one of their emergency departments for a coin stuck in the oesophagus, that is the food pipe. Patients were eligible for bougienage if they have had a witnessed coin ingestion less than 24 hours before presentation and if oesophageal coin position was confirmed by chest x-ray and there was no history of oesophageal disease, surgery or any other foreign body. The average age of the patients was 3.7 years. Bougienage was used to manage 372 cases while 248 were treated with endoscopy. Endoscopy was successful in all but one patient, while bougienage was successful in all but 17 patients. These 17 patients were then treated successfully with endoscopy. On an average, the length of stay with endoscopy was 6.1 hours, whereas with bougienage, the stay was just 2.2 hours. No complications occurred in any of the patients. The findings indicate that bougienage is a safe and effective alternative to endoscopy for removing coins acutely lodged in the oesophagus in properly screened patients. Moreover, use of bougienage may significantly reduce the length of stay and hospital charges.