FOREIGN BODY IMPACTION AT LOWER END OF OESOPHAGUS.

Infants put almost everything into their mouths, and toddlers eat just about anything.  Of all the cases of foreign body ingestion reported each year, 80 percent occur in children [ 1-4 ]..  The majority of foreign body ingestions occur in children between the ages of six months and three years. [ 1,5,6 ] Oesophageal foreign body impaction is an emergent condition that presents with acute dysphagia, chest pain, and foreign body sensation [8]. If left untreated, it can result in local oesophageal injury such as oesophagitis or ulceration, oesophageal obstruction / perforation or rupture (Boerhaave’s syndrome),  bowel obstruction from downstream migration of previously impacted items.[8,9,10,11,] Young children may be particularly vulnerable to Oesophageal foreign body impaction due to a small oesophagus diameter coupled with the tendency to put a variety of objects directly into their mouth. Fortunately, most foreign bodies that reach the gastrointestinal tract pass spontaneously. Only 10 to 20 percent will require endoscopic removal, and less than 1 percent require surgical intervention [ 1,5,7 ]. Although mortality from foreign body ingestion is extremely low, deaths have been reported. [ 5,8,9 ] The most common site of foreign body impaction is at the upper end of Oesophagus, as it is the narrowest part of the GI tract ( >80% cases) and very rarely we have impaction at the lower end of oesophagus. Here we will be presenting a rare case of Coin impaction at the lower end of oesophagus with diagnosis and management.