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April 1988

Radiological Case of the Month

Am J Dis Child. 1988;142(4):459-460. doi:10.1001/archpedi.1988.02150040113032

A 14-year-old mentally retarded boy was investigated for microscopic hematuria of one month's duration. He had had intermittent emesis after meals until he was 9 years old but no gastrointestinal symptoms since then. A preliminary roentgenogram during an intravenous urographic examination showed metallic objects in the right upper quadrant (Fig 1).

Denouement and Discussion 

Down's Syndrome, Duodenal Stenosis/Annular Pancreas, and a Stack of Coins  An upper gastrointestinal tract examination with barium showed obstruction of the second part of the duodenum by a stack of coins at the site of duodenal stenosis (Fig 2). The coins were movable within the the first and second parts of the duodenum. Results of the remainder of the gastrointestinal examination with barium were normal. Even on close questioning, the patient denied that he had swallowed the coins.Small round or oval objects that enter the stomach nearly always pass uneventfully through the gastrointestinal tract without requiring