Successful endoscopic management of subacute intestinal obstruction presenting 3 years after lodgement of a coin in the duodenal cap.

rn e M et a.Su ccssfu En d ocop ic M an ag em en t of Su b cu te In tstin lO b stru cion · En d ocop y 20034:594 Individuals who ingest coins are usually simply observed, because the majority of coins which pass into the stomach move unimpeded through the gastrointestinal tract [1,2]. It is rare for ingested coins which pass through the pylorus to lodge in the small bowel, and even rarer for this not to present acutely but rather several years later. A 52-year-old man presented with a 9-month history of intermittent epigastric pain and profuse vomiting, each bout lasting a few hours. These episodes settled spontaneously, and he was entirely well in between. The patient had accidentally swallowed a coin over 3 years previously which had not obviously passed. Physical examination showed normal findings. An abdominal plain film showed a coin-shaped metallic density in his mid-abdomen. Gastroscopy revealed an Irish 50 pence coin in the duodenal cap (Figure 1). The coin was firmly adherent to the duodenal mucosa on one of its edges, but appeared to swing about this axis and intermittently occlude the pyloric opening. Therewas a duodenal diverticulum just proximal to the site of the coin. The coin was dislodged with a snare and retrieved using a basket (Figure 2). At follow up 3 months later, the patient remained well with no further gastrointestinal symptoms.