Double coin in the upper esophagus mimicking a button battery: a case report

Foreign body ingestion (FBI) is common among children, with coins being the most frequently ingested object. Nevertheless, radiographic differentiation can become difficult when two juxtaposed coins resemble the contour of a button battery (BB).

This paper describes an 8-year-old boy who presented with drooling, vomiting, and absolute dysphagia. Chest radiographs revealed a radiopaque object in the upper esophagus with a double-rim or "halo" sign, raising concern for a BB. Due to the patient's symptoms and radiologic uncertainty, we performed urgent esophagoscopy under general anesthesia. Intraoperative findings revealed two stacked coins lodged in the upper esophagus. The surrounding esophageal mucosa displayed circumferential necrosis and eschar formation, although no perforation was present. Postoperative computed tomography angiography (CTA) was performed as a precaution and confirmed no vascular injury. We managed the patient conservatively where he then was discharged after 2 weeks in stable condition. Upon follow-up imaging, there were no complications, and we confirmed mucosal healing.

This case highlights the diagnostic challenge posed by stacked coins, which may radiographically mimic BB. Although inert, stacked coins can still cause significant esophageal injury, particularly when impacted for an unknown duration. In symptomatic cases, urgent intervention remains essential regardless of object type. Lateral imaging and careful interpretation can help avoid unnecessary alarm or delayed management in similar scenarios.