ABSTRACT 859

Abstract

Background and aims: Lithium battery ingestion can cause corrosive esophageal ulcer. Aims: The aim of this study is to assess the appropriateness of treatment for corrosive ulcer, especially using steroids for preventing esophageal stricture. Methods: A 20 month-old boy presented to the emergency room 1.5 hour after swallowing a lithium battery 20mm in diameter. By esophagoscopy the battery was found at the bottom of pyriform sinusitis but it could not be removed. Under direct laryngoscopy, the Otorhinolaryngologist finally removed the battery 7.5 hour after ingestion using long forceps. The posterior wall of the esophagus had a 3rd degree alkali burn and the patient suffered from larygeal edema. We performed (i) endotracheal intubation, (ii) insertion of nasogastric tube for tube feeding and preventing esophageal stricture, (iii) administration of dexamethasone for preventing esophageal scarring and stricture with an initial dose of 1mg/kg/day. Results: Nine days later, laryngoscopy revealed that the esophageal ulcer had improved and there was no longer any laryngeal edema. The dose of dexamethasone was reduced to 0.75mg/kg/day for 7 days, following 0.5mg/kg/day for the next 7 days, 0.35mg/kg/day for the next 7 days, 0.25mg/kg/day for the next 7 days and 0.15mg/kg/day for the next 7 days. Upper digestive tract test revealed no evidence of leakage nor stricture. The patient started to eat minced meal and nasal gastric tube was removed 30 days after admission. Four months later, he was able to eat normally. Conclusions: In this case, long term administration of steroids may prevent esophageal stricture. Further studies are needed to decide the appropriate dose and period of steroid administration.