Conservative management of coin ingestion in a toddler using serial plain radiography in Zambia: An imaging case report

Coin ingestion is a frequent reason for paediatric radiology referrals, with most cases resolving spontaneously without complications. This imaging case report describes the diagnosis and conservative management of a 2-year-old boy who accidentally ingested a two-Kwacha coin at a public hospital in Zambia. The child remained asymptomatic throughout his hospital and home stay, allowing for a non-invasive approach involving serial plain film radiographs to monitor the coin’s progression through the gastrointestinal tract. Over three days, imaging confirmed the coin’s movement from the oesophagus to the mid-abdomen, culminating in its natural expulsion on the fourth day. This case highlights the crucial role of plain film radiography in both diagnosing and monitoring foreign body ingestion in children, particularly in low-resource settings. It also highlights significant systemic challenges, including the lack of paediatric radiographers, the absence of national paediatric imaging guidelines, a critical shortage of radiologists, and the unavailability of electronic systems for patient data and radiographic image management. Despite these limitations, the successful outcome supports existing evidence that asymptomatic paediatric patients with coin ingestion can be safely managed through careful observation and serial imaging, thus avoiding the risks associated with invasive procedures and sedation.