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.