Coins are among the most common foreign bodies ingested by children, especially those below 5 years of age. Early endoscopic retrieval of esophageal coins minimizes the risk of serious complications. However, significant morbidity and mortality are reported when coins are retained in the gastrointestinal tract for prolonged periods of time. We report a case in which a coin was retained in the upper esophagus for 4 years and presented a distinctive clinical course. An esophageal coin retained for a prolonged period may place the patient at a risk of complications such as tracheoesophageal fistulas. The management of patients with complicated aerodigestive tract foreign bodies is challenging. To avoid a delayed diagnosis and to improve the patients' safety, the quality of medical care in rural areas should be monitored by implementing continuous educational programs for primary physicians.