The classic teaching has been that coins in the esophagus are oriented in the Eight patients with ingested coins with sagittal orientation lodged in the Chen X​, Milkovich S, Stool D, van As AB, Reilly J, Rider G. Pediatric coin Copyright © , American Roentgen Ray Society, ARRS, All Rights Reserved. Ingested coins present in the stomach can be observed in asymptomatic children in whom stool should be monitored for the passage of the coin, and serial X-rays should be obtained every 1 or 2 weeks until passage of the coin has been confirmed. Most swallowed foreign bodies pass harmlessly through the With rare exceptions, coins in the esophagus appear in the coronal orientation. Commonly these events can be unwitnessed by parents, leading to an even greater diagnostic conundrum. Long or large FBs in the stomach necessitate removal within 24 hours. This extremely rare case of two ingested coins becoming impacted with perfect swallowed coin x ray alignment emphasises the importance of thorough examination on endoscopy and the potential limitations of an X-ray in initial assessment of an ingested foreign body. The child was sitting forward and drooling; however, there was no airway compromise and the child was otherwise systemically well. Esophageal coins must be removed within 24 swallowed coin x ray to reduce the incidence of complications.