• Julio César Moreno Alfonso, Alberto Pérez Martínez, Ada Yessenia Molina Caballero, Néstor Busto Aguirreurreta, Concepción Goñi Orayen, Francisco José Gil Sáenz, and Leire Elcano Sarasibar.
• Hospital Universitario de Navarra. Servicio de Cirugía Pediátrica. Pamplona, España.
• Colomb Medica. 2021 Oct 1; 52 (4): e5005016.

Case DescriptionA 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects.Clinical FindingsThe girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history.Treatment And OutcomeWith the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications.Clinical RelevanceUnusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.Copyright © 2021 Colombia Medica.

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