Button battery injury causing an aorto-oesophageal fistula in a 1-year-old child – Sengstaken–Blakemore tube, a life-saving bridge during surgery

Abstract

ABSTRACT The ingestion of button batteries (BB) by children has become more common, and this can cause oesophageal injury, perforation and even life-threatening haemorrhage. A 1-year-old infant who presented to the emergency room with loss of appetite and vomiting, and was discharged with suspected gastro-enteritis is described. One week later she returned with haematemesis. Chest radiography detected a BB in the stomach and it was removed operatively. Haematemesis and hypovolaemic shock ensued and, while waiting for the paediatric cardiothoracic team, the profuse oesophageal bleeding was controlled using an adult-size Sengstaken—Blakemore tube (SBT). An aorto-oesophageal fistula at the aortic arch was identified and repaired. This case highlights the importance of suspecting ingestion of BB, and performing a chest radiography in children who present with swallowing difficulties, haematemesis and haemodynamic instability. The adult-size SBT was well tolerated by the child and was lifesaving in controlling the bleeding from the aorta. Abbreviation AEF: aorto-oesophageal fistula; BB: button battery; CTA: computed tomography angiography; ER: emergency room; GI: gastro-intestinal; SBT: Sengstaken–Blakemore tube