17 July 2020

"Doctor, on a reçu un enfant à la pediatrie. Elle a avalé l'argent." We have received a child at pediatrics. She swallowed a coin an hour ago.

The x-ray confirmed the story. A large, circular, radio-opaque object--consistent with the 25 franc coin the family said she had swallowed--sat somewhere near the level of her collarbone. She had no symptoms. "Don't eat or drink anything. We'll get it out in the morning under anesthesia."

In the morning, I unlocked the operating room and explained the situation to our anesthetist. I repeated the x-ray, and the coin hadn't budged. After Philippe gave her ketamine, I intubated. Her vocal cords were easy to see. This was the easy part. Now for the hard part--fishing out the coin. I took a small urinary catheter from its sterile package and attempted to pass it into the esophagus. The esophagus pushed back. I tried advancing the catheter with forceps once it was in the back of the throat. It was too flexible. In the process of trying to manipulate the catheter, I also dislodged the endotracheal tube--an uncuffed pediatric tube. I quickly found the vocal cords and re-intubated. Emmanuel, our OR nurse this month, found a flexible guidewire that could fit through the catheter. Perfect! With the wire and the forceps, the catheter easily slid down into the esophagus without resistance. Haroun--our Chadian doctor on surgery this month--pushed 10 ml of water into the catheter's balloon port. I tugged on the catheter and it started to slide out. Then I felt resistance--the inflated balloon was just below the coin, pushing on it. Emmanuel peered into the oropharynx and exclaimed when he saw the golden color of the 25 franc coin appear. He grabbed it with forceps while I continued to hold traction on the catheter. We called the family in to show them the coin, and the mother took it to show the rest of the family. Or maybe to tuck away safely in her coin purse. Soon the anesthesia wore off, and the patient was extubated.

25 francs successfully reimbursed!